Number of Highly Rated PDP Contracts Shrinks in 2023

Only 9% of Medicare beneficiaries who sign up for a stand-alone Prescription Drug Plan (PDP) in 2023 will be in contracts rated 4 stars or higher, compared to 42% in the 2022 plan year, CMS recently estimated based on current enrollment figures. The average star rating for stand-alone PDP plans declined to 3.25 in 2023 from 3.70 in 2022, with only two PDP contracts receiving a 5-star rating. The change in distribution is largely due to adjustments in measure scores, and “the unusual circumstance of nearly all contracts qualifying for the regulatory adjustment for extreme and uncontrollable circumstances” driven by the pandemic, which led to higher than normal 2022 Star Ratings distributions, CMS explained in a fact sheet accompanying the release of the 2023 Star Ratings.

Based on current enrollment, 53% of Cigna Corp.’s membership is estimated to be in a 4-star contract in 2023. CVS Health Corp.’s SilverScript Insurance Company, the largest PDP sponsor, will have all of its enrollees in a plan with 3.5 stars. Meanwhile, Clear Spring Health’s PDP contract, which is estimated to cover almost 300,000 enrollees, only scored 1.5 stars.

Scores for most 2023 Star Ratings measures changed only slightly compared to data from the prior year at the national level. The Statin Use in Persons With Diabetes measure saw the largest increase. Plans’ scores on two member experience measures — Rating of Drug Plan and Getting Needed Prescription Drugs — will decline in 2023.

NOTES: Analysis does not include enrollment data from contracts that were too new to be rated, or did not have enough data available to measure a star rating. For Complaints About the Plan and Members Choosing to Leave the Plan, a lower score is better. The Complaints About the Plan measure is a rate of complaints about the plan per 1,000 members.

SOURCES: CMS. DHP, AIS’s Directory of Health Plans, as of October 2022.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.

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