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.
By: Yoona Kim, PharmD, PhD, Co-Founder and CEO of Arine
A version of this article was originally published in Becker’s Payer Issues on September 29, 2025.
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 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.
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:
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.
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.
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:
With these capabilities, plans can deliver targeted, measurable impact—without burning out their teams.
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.