Part D adherence measures save billions, says Ben Shirley of PQA | Part 1

Measuring whether people take their medications might not seem like such a big deal, but it has saved billions of dollars, says Ben Shirley.

A 2024 CMS assessment concluded that “nearly $30 billion in healthcare costs were avoided between 2016 and 2021 related to PQA adherence measures,” Shirley said in an interview with Managed Healthcare Executive (MHE)

PQA stands for Pharmacy Quality Alliance, which is an independent nonprofit organization headquartered in that develops standards and guidance for medication safety, adherence and appropriate use. Its members include health plans, pharmacy benefit managers, pharmacy schools and government agencies. Shirley is the organization’s senior director of performance measurement.

In this segment of his interview with MHE, Shirley explains that PQA was founded in 2006 when Medicare Part D went into effect and, in Shirley’s words, “the government became the biggest payer for drugs.” That development put a spotlight on whether drugs were being prescribed and used in the right way. PQA was founded as a private-public partnership to work toward ensuring high-quality use of medications, Shirley explained. PQA measures account for a significant part of a Part D plan’s star ratings, a system for measuring plan quality that has significant financial implications for plans.

By providing incentives to have patients take medication as prescribed, PQA’s quality measures are instrumental in reducing the number of hospitalizations and emergency department visits, an effect that reduces healthcare spending and results in better health outcomes for patients, Shirley said,

Shirley noted that although PQA works closely with CMS, its measures are still just recommendations that CMS can either accept or reject.