(6) Characteristics of Medicare Part D eligible patients at risk for qualifying for the concurrent use of opioids and benzodiazepines Star Measure

Background: : The Medicare Star Ratings system is used by consumers to compare the quality of health plans. The ratings are published each year by the Centers for Medicare and Medicaid Services (CMS). Beginning in January of 2025, the concurrent use of opioids and benzodiazepines (COB) measure will be included in the rating calculation.

Objective: : To explore the characteristics of Medicare Part D members at risk of qualifying for the COB measure.

Methods: : Medicare eligible members who had at least one day of overlap during calendar year 2024 of both an opioid (OP) and benzodiazepine (BZD) prescription claim were gathered and followed from the date of the initial claim to the end of the calendar year. Members had to have an index date in the first six calendar months. To be classified as qualifying for the measure, members had to have two separate claims for both OPs and BZDs and reach a minimum of 30 days of overlap. Characteristics of age, sex, initial claim type, total OP and BZD claims, and time from index to qualifying were compared for those who qualified versus those who did not reach the threshold.

Results: : A total of 2,835 members were identified during 2024 as being at risk of qualifying for the COB measure. Of those, 1,364 (48.1%) reached the 30 day overlap requirement. Compared to non-qualifiers, those who qualified had a mean age of 67.6 years (vs 69.8, p. < 0.0001), were more likely to be female (72.8% vs 69.3%, p.=0.04), have a mean BZD claim count of 7.8 (vs. 4.1. p. < 0.0001), a mean OP claim count of 9.7 (vs 5.5, p. < 0.0001), and have a mean days from index claim to qualifying of 92.6 (p. < 0.0001). For those who qualified, the largest proportion met the 30 day overlap criteria between 45 to 90 days post index claim (n=414, 30.4%).

Conclusions: : With the CMS addition of COB to the Star Measure ratings beginning with calendar year 2025 data, it is important for plans to understand the population at risk of qualifying in order to tailor interventions and improve their Star Ratings. This study indicates that the key time frame for intervention is within the first 90 days post index claim.

Sponsorship:: MedImpact Healthcare Systems, Inc.