The percentage of Part D beneficiaries, 18 years of age or older who received prescriptions for opioids with an average daily dosage greater than or equal to 90 morphine milligram equivalents (MME) over a period of 90 days or more. The opioid episode starts at the date of the first opioid prescription claim and the end of the enrolment episode must extend at least 90 days from the first opioid prescription claim.

The number of member-years of beneficiaries in the denominator with an average daily MME greater than or equal to 90 MME during the opioid episode.

The number of member-years of enrolled beneficiaries, 18 years or older, with at least 2 prescription claims of a prescription opioid on unique dates of service and at least 15 cumulative opioid days supply over a period of 90 days or longer during the measurement period.

Contracts with 30 or fewer enrolled member-years (in the denominator), beneficiaries enrolled in hospice, with a cancer diagnosis, with a sickle cell disease diagnosis or receiving palliative care during the measurement year were excluded.

Prescription Drug Event (PDE) data files submitted to CMS Drug Data Processing System (DDPS), Common Medicare Environment (CME) for enrolment information, the Minimum Data Set (MDS) for nursing home information, the Common Working File (CWF) ICD-10-CM codes to identify diagnoses, the Encounter Data Systems (EDS) used to identify diagnoses based on ICD-10-CM codes, and the PQA Medication Lists, which include the NDCs for this measure.

www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data

www.cms.gov/files/document/2025-star-ratings-technical-notes.pdf