Summary Rating of Prescription Drug Plan Quality
This summary rating gives an
on the drug plan’s quality and performance in
15 different topics in 4 categories
Drug plan customer service:
Includes how well the plan handles calls from members, makes decisions about member appeals for drug coverage, and handles new enrollment requests in a timely way.
Member complaints, problems getting services, and improvement in the drug plan’s performance:
Includes how often Medicare found problems with the plan and how often members filed complaints against the plan and choose to leave the plan. Includes how much the plan’s performance has improved (if at all) over the last two years.
Member experience with the plan’s drug services:
Includes ratings of member satisfaction with the plan.
Patient safety and accuracy of drug pricing:
Includes how well the plan provides accurate pricing information for the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition. Includes information on whether members are taking certain medications as directed.
This information is gathered from several different sources. In some cases it is based on member surveys. In other cases, it is based on reviews of billing and other information that plans submit to Medicare, or on results from Medicare’s regular monitoring activities.
Why is the summary rating important?
The summary rating makes it easy to compare drug plans based on quality and performance.
In addition to using the summary rating:
You can look up the plan’s rating in each of the 4 categories that make up the summary rating.
You can also look up how well the plan is doing in the 18 different topics that make up the rating in those 4 categories.