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Health Plans & PBMs

Your network can move the needle.

Pharmacy-level visibility into the Part D measures that drive Star Ratings: triple-weighted adherence (D08, D09, D10), SUPD, the single-weighted safety measures (COB, Poly-ACH) now scored in Star Ratings, and MTM completion (D11 returns to scoring in 2029 SR).

3x
CMS weight on PDC adherence measures
7
Part D measures covered, including D11 (display only until 2029 SR)
2029
Star Ratings year D11 CMR returns to scoring (MY 2027 data)
The Blind Spot

Your network average hides the pharmacies dragging it down.

You track aggregate PDC across your network. But aggregate data doesn't show which pharmacies are missing quality targets, which measures are dragging down Star Ratings, or where medication review programs are falling short.

Plans need pharmacy-level visibility, not just network averages.

And the landscape is shifting. COB and Poly-ACH are now scored Part D measures, single-weighted beginning with the 2027 Star Ratings. D11 CMR returns to scoring in 2029. Plans with site-level data across every relevant measure hold the advantage.

Seven Measures. One Platform.

Seven Part D measures. Three carry triple weight.

One platform covering every Part D adherence, safety, and MTM measure in Star Ratings: the three triple-weighted PDC measures, SUPD, the single-weighted safety measures (COB, Poly-ACH), and D11 CMR (returns 2029 SR).

D08
Diabetes Medication Adherence
PDC for noninsulin antidiabetic medications. Weighted 1x for 2028 SR (MY 2026) while CMS phases in sociodemographic risk adjustment. Returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D09
RAS Antagonist Adherence
PDC for blood pressure medications. Weighted 1x for 2028 SR (MY 2026) while CMS phases in sociodemographic risk adjustment. Returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D10
Statin Adherence
PDC for cholesterol medications. Weighted 1x for 2028 SR (MY 2026) while CMS phases in sociodemographic risk adjustment. Returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D12
SUPD
Statin use in persons with diabetes. Fills-based measure.
Single-weighted
D11
CMR Completion Rate
Display measure for MY 2025 through 2026. Returns to scoring for 2029 Star Ratings (MY 2027 data).
Returns 2029
COB
Opioid-Benzodiazepine Overlap
Members with 30+ concurrent days on both drug classes.
Scored 2027 SR
Poly-ACH
Anticholinergic Polypharmacy
Adults 65+ on multiple anticholinergic medications.
Scored 2027 SR
Every Measure. Every Pharmacy.

Which pharmacies are hitting PDC targets, and which aren't?

Monitor diabetes, RAS antagonist, and statin PDC at both the network and individual pharmacy level. Quickly identify which locations meet the 80% threshold and where adherence is falling short. SUPD tracking surfaces members with diabetes who haven't filled a statin, a gap that's easy to address once it's visible.

Network PDC Performance
Diabetes (D08)84.2%
RAS Antagonist (D09)81.8%
Statin (D10)74.2%
SUPD (D12)79.1%
Sample data for illustration only
CMRs. TMRs. One Network View.

Are your pharmacies completing CMRs or just billing them?

Three medication review workflows across your pharmacy network, tracked centrally and reported to leadership.

01

CMRs

Comprehensive Medication Reviews. Pharmacists schedule, track, and complete CMRs inside PillCoach. Plan leadership sees completion rates network-wide. D11 scores in 2029 Star Ratings (MY 2027).

02

TMRs

Targeted Medication Reviews: focused interventions for specific patients with structured documentation and completion tracking.

03

MedRecs

Medication Reconciliations: standardized reconciliation workflows across every pharmacy in your network.

D11 (CMR Completion Rate) returns to Star Ratings scoring in 2029 (based on MY 2027 data). Plans that build consistent CMR programs now will have 12+ months of refined workflows when scoring begins, while others are still ramping up.
Two Safety Measures. Scored Now.

Two safety measures now count toward your Star Rating. Is your network working them?

COB and Poly-ACH count toward Star Ratings starting with 2027. Every measurement year now feeds a scored rating, so pharmacy-level programs pay off in the next cycle.

Scored from 2027 SR · Weight 1

Opioid-Benzodiazepine Overlap (COB)

CMS will track members with 30+ concurrent days on both opioids and benzodiazepines. PillCoach's medication review workflows help pharmacists identify these members and initiate interventions.

Scored from 2027 SR · Weight 1

Anticholinergic Polypharmacy (Poly-ACH)

Members 65+ on two or more anticholinergic medications for 30+ overlapping days. TMRs and MedRecs help pharmacists identify candidates for deprescribing conversations.

Both are single-weighted process measures in the CMS 2027 Star Ratings. Pharmacy-level programs affect the measurement years now being scored.

Every Pharmacy. One View.

Pharmacy-level performance. Not just network averages.

Performance data by location across every adherence and MTM measure. See which sites are on target, which need support, and how the network is trending quarter over quarter.

Pharmacy-level PDC vs. your network average
MTM completion by pharmacy, trended over time
Performance trending across all seven measures
Identify leading and lagging locations
Network Performance · Diabetes PDC
Cityview Pharmacy
92.1%
Lakeside Health Rx
87.4%
Metro Care Pharmacy
83.0%
Summit Drug Co.
78.2%
Central Rx
71.5%
Sample data for illustration only

Adherence, MTM, safety, and comms. One platform.

Clinical Data Capture

Pharmacist-documented vitals and labs: BP, glucose, A1C, cholesterol, pulse ox, weight

Vaccines and Registry

Vaccine tasks, registry history, and dose submission across pharmacy teams

Workflow Tracking

Activity feeds and performance metrics for plan administrators and pharmacy managers

HIPAA Infrastructure

Encryption in transit and at rest, role-based access, and audit logging on HIPAA-compliant infrastructure

Your Program. Your Control.

No vendor middleman. No black-box reporting.

Some plans want direct control over their adherence programs, with no vendor middleman and no black-box reporting. PillCoach gives your clinical operations team a single platform to run the full program in-house, from PDC interventions to MTM completion to patient outreach.

Central command for your clinical ops team

Your pharmacists and clinical staff use PillCoach as their daily operating system. They manage adherence interventions, complete CMRs and TMRs, document clinical encounters, and coordinate patient outreach from one login.

Full visibility without the vendor dependency

Every metric your team needs, including adherence rates, review completion, and clinical documentation, is visible from a single view. You set the workflows, the priorities, and the pace, on infrastructure that scales with your program.

Lower cost than managed services

Many managed adherence programs charge per member per month and keep the operational relationship at arm's length. Running PillCoach in-house gives your team the same capabilities with direct control over execution and predictable platform costs.

One Platform. Two Models.

Network-wide or in-house. Same platform either way.

Whether you want to equip your pharmacy network or run adherence operations internally, PillCoach adapts to how your organization works.

NETWORK

Deploy across your pharmacies

PillCoach runs inside every pharmacy in your network. Pharmacists use it daily to manage adherence gaps, complete MTM reviews, and document clinical encounters. Your plan gets visibility into performance across every location and every measure.

  • Pharmacy teams use PillCoach as their daily workflow
  • Plan leadership sees network-wide performance dashboards
  • Standardized MTM and clinical documentation across all sites
  • Scales from a single pharmacy to a full network
IN-HOUSE

Operate it yourself

Your clinical ops team uses PillCoach as the operating system for adherence management. Set priorities, assign interventions, monitor outcomes, and report to leadership, all under one roof without third-party overhead.

  • Your clinical staff manages workflows directly
  • Full control over program priorities and pacing
  • Lower cost than outsourced managed services
  • Same platform, same measures, your team

Ready to see performance across every pharmacy and every measure?

30-minute walkthrough. We'll show you the platform, the measures, and what network-wide visibility looks like in practice.

Schedule a Briefing
No commitment required.