Life sciences companies are continually seeking innovative ways to align their objectives with the broader goals of the healthcare ecosystem. One often overlooked yet crucial metric in this alignment is Star Ratings for Medicare Advantage plans (Medicare Part C and commonly Medicare Part D) and standalone prescription drug plans (PDPs), which offer Medicare Part D coverage only. Each year, the Centers for Medicare & Medicaid Services (CMS) publishes contract-level Star Ratings, which assess the quality and performance of these plans. (For a primer on Star Ratings, see the background section below.)
Understanding the Star Rating measures that contribute to a contract’s overall Star Rating can offer a wealth of insights to life sciences companies that are trying to identify and pursue areas of mutual interest with plan sponsors and providers. Life sciences companies can leverage this measure-level Star Rating information to facilitate more strategic collaborations, drive better clinical outcomes, and ultimately enhance the value delivered to patients. This paper will discuss a subset of Star Rating measures, each influencing a plan’s overall Star Rating differently, yet all offering opportunities to advance the standard of care and patient experience to the mutual benefit of life sciences companies, plan sponsors, and ultimately, plan members.
1. Star Ratings surrounding the drug plan experience: Helping improve patient satisfaction
Star Ratings include measures of the member’s experience with the drug plan, including the ease of getting needed prescription drugs. Improving this measure may be of mutual interest to the drug plan and life sciences companies as it impacts a patient’s perceived ability to start and stay on therapy. This measure may be driven largely by patient experience at the pharmacy counter, with mail-order pharmacies, or with other specialty pharmacy providers, as well as their ability to get needed prescription drugs in a timely manner. Ensuring that prior authorization criteria are clinically appropriate, consistent with drug labels, and easily understood may improve the ease of accessing necessary medications. Life sciences companies can partner with or educate plans on product indication and expected place in therapy to help ensure that criteria are easily understood and easy to navigate. Additionally, there may be opportunities for life sciences companies to work with plans on point-of-sale criteria, such as smart edits, which are automated checks to identify appropriateness of therapy before the claim is fully processed, to allow plans to ensure appropriate drug use without undue burden to the patient or provider when clinically appropriate. These approaches can help drug plans ensure that patients are getting clinically appropriate medications without unnecessary delays. Life sciences companies can collaborate with plan sponsors to help streamline these processes, thereby enhancing the patient experience and ensuring that medications are accessible but used appropriately, which may ultimately lead to increased prescription utilization and better clinical outcomes. This collaboration can lead to improved patient and provider satisfaction, better adherence to treatment plans, higher standards of care, and ultimately higher Star Ratings for Medicare Advantage plans and standalone PDPs.
2. Star Ratings tied to chronic conditions: Encouraging patient adherence in disease management
Drug adherence measures for chronic conditions such as diabetes, hypertension, and cholesterol management are heavily weighted in the overall contract-level Star Rating calculation, and are critical success measures for plan sponsors to achieve in disease management. These measures have a strong overlap with the priorities of life sciences companies aimed at helping patients start and adhere to clinically appropriate treatment. By supporting initiatives that promote adherence, life sciences companies and plan sponsors can help ensure that patients receive the full benefit of their prescribed therapies, which can lead to better health outcomes and higher Star Ratings for plans.
3. Star Ratings related to cancer screenings: Facilitating timely routine screenings, early diagnosis, and guideline-concordant care
Life sciences companies with an oncology focus talk about advancing early diagnosis of cancer and ensuring that care adheres to established clinical guidelines or pathways. Two measures focused on appropriate screening for breast and colorectal cancers in Medicare Advantage Star Ratings directly overlap with these priorities. Life sciences companies can partner with plan sponsors and providers to facilitate earlier detection of diseases through screenings, care gap identification, and provider education, thereby helping increase earlier diagnosis rates, improve patient outcomes, and reduce long-term healthcare costs. Additionally, aligning with these measures reinforces the importance of guideline-concordant care (care that adheres to evidence-based clinical guidelines or pathways), which is a cornerstone of effective and efficient care for all stakeholders in the healthcare ecosystem.
4. Influenza vaccine Star Rating: Strengthening patient engagement and education
The influenza (flu) vaccine Star Rating measure tracks the number of enrollees who get an annual flu vaccine. This metric presents a unique opportunity for life sciences companies to partner with plan sponsors. Encouraging patients to receive their flu vaccination not only promotes preventive care but also increases patient interactions with healthcare providers, pharmacists, and other healthcare professionals. This touchpoint can be leveraged to educate patients about other guideline-recommended vaccinations and broader health-management strategies. Life sciences companies can play a crucial role in supporting these educational efforts, ultimately contributing to better patient health and increased vaccination rates.
Why focusing on Star Ratings is vital for life sciences companies
Star Ratings are an important focus for Medicare Advantage and standalone PDP sponsors, influencing patient care, plan selection, and market dynamics. This article focuses only on select Star Rating measures but helps underscore the potential collaboration opportunities for life sciences companies. Understanding these measures can offer numerous opportunities to partner with plan sponsors on initiatives including enhancing patient engagement, improving medication adherence, promoting early diagnosis, supporting preventive care, and engaging in value-based care arrangements. By understanding and prioritizing Star Ratings, life sciences companies can partner with plan sponsors to provide a higher standard of care, better patient outcomes, and more efficient healthcare delivery.
Companies that monitor changes to Star Ratings and adapt as the measures evolve will be in a better position to collaborate successfully with plan sponsors. Staying informed about updates to Star Ratings enables life sciences companies to anticipate market shifts, align their strategies with plan sponsor priorities, and identify new opportunities for partnership, such as leveraging Star Ratings measures in value-based contracts with plan sponsors.
As the number of people eligible for Medicare continues to increase, the influence and significance of Star Ratings will become only more pronounced for Medicare Advantage and standalone PDP plan sponsors aiming to attract and retain members, making it an opportunity for life sciences companies to integrate them into their strategic planning and operational initiatives.
1 Centers for Medicare & Medicaid Services. (October, 3, 2024). Medicare 2025 Part C & D Star Ratings technical notes. Retrieved November 11, 2025, from https://www.cms.gov/files/document/2025-star-ratings-technical-notes.pdf.
2 Centers for Medicare & Medicaid Services. 2026 Star Ratings measures and weights. Retrieved November 11, 2025, from https://www.cms.gov/files/document/2026-star-ratings-measures.pdf.