According to the American Heart Association, 2,500 people die from cardiovascular disease every day in the United States. For patients with diabetes and other chronic conditions, the risks are even higher, making early, consistent use of preventive therapies like statins critical. Statins are proven to lower cholesterol and reduce the likelihood of heart attack, stroke, and other life-threatening complications, yet too many patients either never start therapy or struggle to stay on it.
For health plans, this reality highlights the need to proactively address statin therapy. In addition to the importance of adherence to patient outcomes, low adherence directly affects performance in HEDIS and Medicare star ratings, two of the most influential measures of quality. Even modest gaps in statin therapy can translate into lower scores, decreased reimbursement, and diminished member trust. That’s why adherence to statin therapy must be viewed as both a matter of clinical best practice and as a strategic priority.
Statin therapy adherence and its impact on quality measures
Statin therapy plays a critical role in reducing cardiovascular risk, particularly for patients with diabetes and other chronic conditions. Because of this, adherence to statin therapy is closely monitored within HEDIS and Medicare star ratings programs.
These measures do more than evaluate prescription patterns. They also directly reflect whether patients are receiving evidence-based care that prevents complications, reduces hospitalizations, and improves long-term health outcomes. Additionally, performance on statin-related measures is also a key driver of quality scores, reimbursement, and competitiveness in the market.
With that in mind, here are some of the ways that statin therapy adherence can impact key quality measures.
Statin use in persons with diabetes (SUPD)
The Statin Use in Persons with Diabetes (SUPD) measure is a core component of both HEDIS and star ratings. It evaluates whether adults aged 40–75 with diabetes are appropriately prescribed statin therapy to reduce their elevated risk of cardiovascular events.
This measure reflects more than regulatory compliance. It’s directly tied to patient safety and long-term outcomes. Cardiovascular disease remains the leading cause of death among individuals with diabetes, and statin therapy has been proven to lower that risk. When SUPD performance is low, it often highlights gaps in identifying eligible patients or in making sure they receive the recommended therapy. For health plans, these gaps can mean lower quality scores and missed opportunities to improve both outcomes and satisfaction.
Medication adherence for cholesterol (Part D)
Another important quality measure is medication adherence for cholesterol (statins) under Medicare Part D. This measure tracks whether patients consistently take their prescribed statin medication, remaining adherent at least 80% of the time throughout the year. Even small drops in adherence can have an outsized impact on overall scores, making this measure a critical focus area for health plans.
Strong performance in this measure demonstrates that patients are maintaining therapy proven to reduce cardiovascular risk. Conversely, poor adherence can contribute to higher rates of hospitalizations, increased costs of care, and a decline in star ratings. Because adherence measures are triple-weighted in the star ratings program, their influence on a plan’s overall performance and reimbursement potential is significant.
3 implications of low HEDIS scores and star ratings
Performance on HEDIS and star ratings measures directly shapes how health plans are reimbursed, perceived, and trusted. When statin therapy adherence measures or other quality indicators fall short, the effects ripple across financial performance, member experience, and market reputation.
1. Revenue impact
Low scores can have a measurable effect on reimbursement. Because star ratings are closely tied to bonus payments and quality-based incentives from CMS, just a small dip in performance can result in significant financial losses. Plans that underperform may also face reduced enrollment revenue, as members migrate to higher-rated competitors. Over time, consistent low ratings can limit a plan’s ability to reinvest in services and infrastructure, creating a cycle of underperformance.
2. Member acquisition and retention
Quality ratings play a key role in member decision-making. Beneficiaries often look to star ratings as a quick, trusted indicator of plan quality when choosing coverage. Low ratings can make it harder to attract new members and may drive existing members to switch to higher-performing plans during open enrollment. Since adherence measures like SUPD and Part D cholesterol are weighted heavily, performance in these areas can have an outsized influence on a plan’s ability to grow and retain membership.
3. Reputational risk
Beyond financial implications, low ratings can damage a health plan’s credibility in the eyes of patients, providers, and regulators. Poor performance suggests gaps in care quality, patient safety, or member support. This perception can erode trust, weaken provider partnerships, and attract greater scrutiny from regulators. In a competitive healthcare environment where reputation and trust are critical differentiators, consistent low ratings can place a plan at a long-term disadvantage.
Because statin therapy adherence directly contributes to multiple high-weighted measures, it’s one of the most influential levers health plans can use to safeguard revenue, strengthen member trust, and improve overall performance.
The proactive shift in statin therapy management
In order for health plans to meet quality benchmarks, they need to make sure that patients start, continue, and stay adherent to therapy over time. Traditionally, statin therapy management has been reactive, with interventions occurring only after adherence gaps are identified or when adverse health events arise. While this approach can address immediate concerns, it often comes too late to protect patients and preserve quality scores.
A proactive model takes a different approach. Instead of waiting for problems to appear, health plans and pharmacists focus on anticipating barriers and addressing them early. In fact, one study on the intervention of clinical pharmacist outreach found that “clinical pharmacists who conduct a telephonic population health intervention can achieve a high rate of success in initiating a moderate- to high-intensity statin therapy in patients with ASCVD.” This shift transforms statin therapy management from a compliance exercise into a strategic driver of patient safety and quality performance.
Key elements of proactive statin therapy management include:
- Early patient identification: Spotting members who meet SUPD or Part D criteria and ensuring they receive the recommended therapy.
- Ongoing monitoring of adherence patterns: Tracking refill data and other indicators to flag potential non-adherence before it becomes a serious gap.
- Personalized patient engagement: Addressing engagement barriers and member abrasion such as side effects, misconceptions about statins, or challenges with cost and access.
- Pharmacist-led interventions: Leveraging the clinical expertise of pharmacists to provide timely counseling, education, and follow-up.
- Integration with quality goals: Aligning statin therapy management efforts with HEDIS and star ratings priorities so that every intervention contributes to both better outcomes and stronger performance.
By shifting from reactive to proactive management, health plans not only reduce the risks tied to non-adherence but also strengthen their ability to consistently meet and exceed quality standards.
Pharmacist-led solutions for statin therapy management
Successfully managing statin therapy adherence requires a proactive approach, and at the heart of this strategy is the expertise of pharmacists. Leveraging specialized medication therapy management technology, these professionals are uniquely positioned to close care gaps, improve patient outcomes, and boost both HEDIS and star ratings performance.
This is where the solutions from Aspen RxHealth become indispensable assets. Our MTM technology empowers both in-house and outsourced pharmacists with the tools they need to proactively engage patients, rather than simply reacting to adherence issues after they've already impacted quality scores.
Here's how our MTM solutions elevate statin therapy management from a burdensome task to a strategic advantage:
- Targeted patient identification: Alliance by Aspen RxHealth enables health plans to quickly identify members who meet SUPD criteria but are not yet on therapy, as well as those at risk of falling below adherence thresholds. This ensures pharmacists can prioritize the right members and close gaps in care more effectively.
- Actionable, patient-centered insights: Through BeWell with Aspen RxHealth, pharmacists gain access to robust patient profiles that highlight medication history, refill behavior, and potential barriers to adherence. With this information at hand, pharmacists can deliver meaningful, personalized consultations that address specific concerns such as side effects, affordability, or misunderstandings about statins.
- Scalable engagement: Our expansive pharmacist community, combined with the telepharmacy capabilities of Alliance, makes it possible to engage thousands of members with consistency and care. Health plans can scale outreach efforts while maintaining personalized, expert interactions that drive better adherence and directly impact HEDIS and star ratings performance.
The ability to improve statin therapy adherence is a powerful lever for success. By partnering with Aspen RxHealth, you can transform your statin management from a reactive process into a proactive, pharmacist-led initiative that safeguards your revenue, strengthens your reputation, and ensures your members receive the highest quality of care. Get in touch with Aspen RxHealth to book your demo.
