The Centers for Medicare and Medicaid Services (CMS) finalized the addition of two new Part D measures for the 2025 measurement year. Both were developed by the Pharmacy Quality Alliance (PQA) and are single-weighted medication safety measures.

The new Part D single-weighted medication measures are calculated from Prescription Drug Events (PDEs) and do not require any new data collections.

Concurrent Use of Opioids and Benzodiazepines (COB)

Rationale: Taking opioids and benzodiazepines together may increase risk of side effects, including sleepiness, falls, confusion, slow or difficulty breathing, and accidental overdose.

• COB analyzes the percentage of Medicare Part D beneficiaries aged 18 and older with concurrent use of prescription opioids and benzodiazepines. Concurrent use is defined as an overlapping day’s supply for at least 30 days.
• COB rate is reported based on calendar year. Patients in the denominator have filled opioid prescriptions two or more times, of at least 15 or more cumulative days’ supply. Patients included in the numerator have filled two or more benzodiazepine prescriptions on different days of service AND have overlapping opioid prescription(s) for 30 or more days.

• COB measure exclusions: beneficiaries in hospice care, with cancer, with sickle cell disease diagnosis, and in palliative care during the measurement year.
• A lower rate indicates better performance

Rationale: Taking multiple medications with anticholinergic side effects can further increase the risk of side effects and lead to serious conditions, including dry mouth, blurry vision, constipation, urinary retention, confusion, and falls.

• Poly-ACH analyzes the percentage of Medicare Part D beneficiaries, 65 years or older, with concurrent use of two or more unique anticholinergic medications during the measurement period.
• Poly-ACH rate is reported based on calendar year. Patients in the denominator have filled the same anticholinergic medication at least two times. Patients included in the numerator have filled two or more unique anticholinergic medications, each with two or more fills, with overlapping or concurrent use for 30 or more cumulative days in measurement year.

• Poly-ACH measure exclusions: beneficiaries in hospice care during the measurement year.
• A lower rate indicates better performance.

Actions to reduce polypharmacy*

At each visit, prescribing providers should review their patient’s full medication list and deprescribe where necessary. If prescribing high-risk medications cannot be avoided, the recommendation is to create a monitoring plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.

Prescribing providers can also follow these recommendations from the Cigna Pharmacist:

• Utilize pharmacists and staff to complete a comprehensive medication review, including over-the-counter medicines, supplements, and vitamins.
  • Drug interactions can lead to unintended side effects.
  • Pill burdens make it difficult to achieve clinically efficacy and medication adherence.
• Educate patients regarding side effects to look for and when to seek medical attention.
• Explain to patients when the risk of harm outweighs the benefits of treatment.
• Avoid prescribing medications to treat side effects of other prescriptions.
• Avoid use of a treatment that is not evidence-based.
• As a precaution, prescribe naloxone for patients on concurrent opioids and benzodiazepines.

Complete a Comprehensive Medication Review (CMR).

• CMRs include review of OTC and herbal medications.
• As individuals age, metabolism and drug clearance changes increase the risk of adverse effects, further heightened by using multiple medications. 
• Anticholinergic medications can cause delirium, memory loss, hallucinations, blurry vision, constipation, dry mouth, elevated body temperature, and increased risk of falls.
• These drugs can also precipitate acute angle-closure glaucoma and urinary retention. 

Polypharmacy contributes to poor medication compliance, drug interactions, medication errors, and avoidable adverse drug events (ADEs).

Poly-Pharmacy Screening tools

• The Anticholinergic Burden Calculator evaluates a patient’s potential for serious anticholinergic effects. This is a good place to start with geriatric patients, as reducing or eliminating anticholinergic burdens can often improve patients’ overall function and quality of life. Consider deprescribing those medications in the highest (level 3) category.
• The Beers List includes medications that pose the highest risk to older patients, along with alternatives. (For the most recent update, see the Journal of the American Geriatric Society.)
• Deprescribing.org provides deprescribing guidelines and algorithms, patient decision aids, and an up-to-date resource list of evidence and research.
• MedStopper allows you to enter a drug list for a specific patient and receive recommendations regarding which medications might be discontinued or switched.

*Prescribers must always practice medicine in accordance with their current medical training, relevant clinical guidelines, and the highest standards of medical ethics. Cigna’s recommendations are not a substitute for professional judgment; any decision regarding patient care should be made based on individual patient circumstances and consultation with appropriate healthcare professionals when necessary.