The percentage of beneficiaries, 18 years or older, who were prescribed at least one initial opioid prescription for more than 7 cumulative days' supply.

The number of member-years of beneficiaries in the denominator with more than 7 cumulative days' supply for opioid prescription claims within any 3-day opioid initiation period.

The number of member-years of enrolled beneficiaries, 18 years or older, with 1 or more opioid prescription claim(s) with a negative medication history during the 90-day lookback period.

Contracts with 30 or fewer enrolled member-years (in the denominator) and beneficiaries with a cancer diagnosis, sickle cell disease diagnosis, enrolled in hospice, or receiving palliative care at any time during the measurement period or the 90 days prior to the measurement period are excluded from the denominator.

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