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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), MTM completion (D11 returns to scoring in 2029 SR), and the new single-weighted safety measures (COB, Poly-ACH) first scored in 2028 Star Ratings.

3x
CMS weight on PDC adherence measures
7
Part D measures covered
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. CMS added COB and Poly-ACH as Part D measures — display in 2027 Star Ratings, first scored in 2028. D11 CMR returns to scoring in 2029. Plans with site-level data across every relevant measure will have the advantage when scoring starts.

Seven Measures. 3x Weight.

Seven Part D measures. Triple-weighted in Stars.

One platform covering every Part D measure in Star Ratings — the three triple-weighted PDC measures, D11 CMR (returns 2029 SR), SUPD, and the new single-weighted safety measures (COB, Poly-ACH) first scored in 2028 SR.

D08
Diabetes Medication Adherence
PDC for noninsulin antidiabetic medications. SDS adjustment: 1x for 2028 SR (MY 2026), returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D09
RAS Antagonist Adherence
PDC for blood pressure medications. SDS adjustment: 1x for 2028 SR (MY 2026), returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D10
Statin Adherence
PDC for cholesterol medications. SDS adjustment: 1x for 2028 SR (MY 2026), returns to 3x for 2029 SR (MY 2027).
Triple-weighted
D12
SUPD
Statin use in persons with diabetes. Fills-based measure.
Triple-weighted
D11
CMR Completion Rate
Display measure for MY 2025–2026. 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 2028 SR
Poly-ACH
Anticholinergic Polypharmacy
Adults 65+ on multiple anticholinergic medications.
Scored 2028 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 straightforward 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, 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 New Measures. Scored 2028.

CMS added two safety measures. First scored in 2028 Star Ratings. Is your network ready?

Most plans haven't operationalized COB or Poly-ACH yet. The window to build pharmacy-level programs before scoring starts is narrowing.

Display 2027 · Scored 2028

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.

Display 2027 · Scored 2028

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 measures display in 2027 Star Ratings and are first scored in 2028 Star Ratings as single-weighted process measures. Plans with pharmacy-level programs running before scoring begins will have a meaningful head start.

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

Vaccine Management

Vaccine task tracking across pharmacy teams

Workflow Tracking

Activity feeds and performance metrics for plan administrators and pharmacy managers

HIPAA Infrastructure

End-to-end encryption, 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 - no vendor middleman, 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 - managing adherence interventions, completing CMRs and TMRs, documenting clinical encounters, and coordinating patient outreach from one login.

Full visibility without the vendor dependency

Every metric your team needs - adherence rates, review completion, clinical documentation - 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 10 pharmacies to 10,000
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.