With the release of CMS Star Ratings for 2026 and updates for the upcoming year, Medicare Advantage and Part D plans are navigating an evolving quality landscape. Adherence measures are shifting from triple- to single-weighted and will incorporate risk adjustment, while the MTM Program Completion Rate for CMR enters its second year as a display measure under expanded eligibility criteria. Plans are also still learning what drives success for the new polypharmacy measures.
On the surface, this might suggest medication-focused strategies can be deferred until the 2027 measure year. In reality, doubling down on a smart medication strategy is one of the most important moves a plan can make right now.
Here’s why.
The Pressure of Rising Cut Points and New Measures
The bar keeps getting higher. With rising cut points across existing quality measures, coverage changes (e.g. coverage gap elimination), new measures being introduced, and social risk factor considerations, the path to 4+ stars is increasingly challenging. To compete for 4+ stars and the critical bonus payments that come with them, Medicare Advantage and Part D plans need a robust, forward-looking medication strategy more than ever. Plans that delay or scale back their medication strategy risk falling behind—not just on adherence, but across their broader quality performance.
What the Best Plans Do: Prioritize Medication Measures
High-performing plans know that medications are at the center of quality, cost, and member outcomes. Even if the weighting shifts, the most successful organizations continue to focus on:
- Medication Adherence — because even small shifts in adherence can be the difference between 3 and 4 stars.
- MTM — because with increasing volumes, it has been one of the most challenging measures to succeed on, but is still a critical touchpoint for engaging members and driving care.
- Statin Starts (e.g. SUPD) — because timely statin initiation has a direct impact on outcomes and quality scores.
- Polypharmacy Measures — because timely deprescribing is key for the new Poly-ACH and COB measures.
The calculation is simple: better medication use leads to healthier members and lower downstream costs by preventing hospitalizations, complications, and avoidable utilization. That’s a return you don’t walk away from.
Timing is Everything: Starting Early Drives Higher Stars
The plans that start the year with a medication strategy in place unlock the greatest opportunities. Early interventions identify risks to adherence and keep members on track from the first fill, ensuring the best possible outcomes and Star Rating performance. Polypharmacy cannot be undone once a member has 30 days of overlap, so catching members before they count against the measure is critical. And with the expanded eligibility for MTM, starting early gives care teams the runway they need to complete CMRs at scale.
Plans that start early have more room to influence outcomes and maximize Stars performance, while those that delay are left playing catch-up.
The Role of Technology: Doing More with Limited Resources
Even the strongest care teams can’t succeed without the right tools. The data is too complex, the member needs too layered, and timelines too tight. Technology-enabled solutions make it possible to:
- Identify members at risk before it’s too late.
- Match medication interventions to members according to their personalized needs with the greatest impact on quality and outcomes.
- Boost care team efficiency, focusing resources on the members who need them most.
- Track ongoing performance to improve both user productivity and quality results.
With these capabilities, plans can deliver targeted, measurable impact—without burning out their teams.
The Bigger Picture
So yes, new measures may be added, weighting may change, and criteria may be updated. But think about what’s really at stake. Medications account for a $528 billion blind spot in the U.S. health system. They’re also one of the most direct levers for influencing outcomes, costs, and member experience.
The plans that step back now risk slipping on Star Ratings, losing bonus dollars, and most importantly, missing the chance to deliver better health for their members. The ones that lean in will be setting the standard for what quality can look like in the years ahead.
This is not the time to pull back. It’s the time to get sharper, act earlier, and be smarter about prioritizing medication use quality.
Yoona Kim, PharmD, PhD, is the Co-Founder and CEO of Arine, the leading AI-powered medication optimization platform that improves patient outcomes and reduces healthcare costs by ensuring that patients receive the most effective and appropriate medications. Learn more at arine.io.
