Medication safety management for special needs plans
We move your members off harmful and ineffective drugs and onto treatments that work. The result for your plan: measurable improvement in utilization costs and Star Ratings.
For I-SNP sponsors
An on-site Clinical Pharmacist, genetic science and whole-regimen review move residents off harmful and ineffective drugs and onto treatments that work. The result for your plan: measurable improvement in utilization costs and Star Ratings.
For D-SNP sponsors
A Clinical Pharmacist, genetic science and whole-regimen review move your members off harmful and ineffective drugs and onto treatments that work. The result for your plan: measurable improvement in utilization costs and Star Ratings.
For C-SNP sponsors
A Clinical Pharmacist, genetic science and whole-regimen review move your members off harmful and ineffective drugs and onto treatments that work. The result for your plan: measurable improvement in utilization costs and Star Ratings.
Choose your plan
Institutional Special Needs Plan
I-SNP
A plan-wide medication view and a pharmacist beside your NPs and consultant pharmacists.
See the institutional programDual-Eligible Special Needs Plan
D-SNP
A pharmacist inside your care team, aimed at the measures you are held to.
See the dual-eligible programChronic Condition Special Needs Plan
C-SNP
Pharmacist review organized by condition cohort, with PGx for cardiovascular drugs.
See the chronic condition programWhat we do
ChorusRx is a pharmacist-led layer on the care model you already run. Five steps, from your claims data to a documented medication decision. We recommend. Your prescriber decides.
Your enrollment roster and medical and Part D claims, under a data use agreement. Medication lists or eMAR exports for the highest-risk members are optional.
Your planWhole-regimen scoring surfaces anticholinergic and sedative burden, nine-plus medications, risky combinations, adherence gaps and recent discharges.
ChorusRx analyticsEach regimen is read as a whole. Pharmacogenomic (PGx) testing is added only where a genotype would change a pending drug decision.
ChorusRx pharmacistThe prescriber, nurse practitioner or care manager gets the reason and an alternative, then accepts, modifies or declines. The decision is documented.
Prescriber decidesMeasure-level reporting, leading indicators monthly, Star and claims results as they arrive. Performance guarantees are negotiated case by case.
Your quality teamYour team ChorusRx The decision stays with the prescriber
How the five steps differ by plan type
A pharmacist on site at the facility, on the care team beside the nurse practitioner. The hospital-to-facility handoff is the key moment.
Works inside the care team and care plan, next to your care managers and your Part D medication therapy management (MTM) program.
Works by condition cohort, such as diabetes, heart failure and cardiovascular disease, against the condition and Part D measures.
In an I-SNP
Step 3 happens on site. A ChorusRx Clinical Pharmacist can be at the facility, on the care team beside the nurse practitioner and attending physician, reviewing at the visit. Step 4 goes straight to them. The facility's monthly consultant-pharmacist review, which federal rules already require for nursing-facility residents,1 continues as it is, and we work from its reports. The hospital-to-facility handoff is where steps 2 and 3 matter most.
In a D-SNP
Steps 3 and 4 sit inside the interdisciplinary care team and the individualized care plan that every SNP must run,2 with the findings shared with the care manager. We coordinate with your Part D MTM program so a member is not reviewed twice for the same purpose.3 We do not replace your health risk assessment or care plan.
In a C-SNP
Step 2 ranks members within each condition cohort, and step 5 reports by cohort against the Part D and Part C measures for those conditions.4 Step 3 adds PGx testing only where a prescriber has a pending decision and a published guideline, for example for clopidogrel.5
One member, illustrated A composite example for explanation only. Not a real member, and not a result.
What you receive
Around every member
The prescriber still decides.
Around every resident
The prescriber still decides.
Around every member
The prescriber still decides.
Around every member
The prescriber still decides.
Where we plug in
Your nurse practitioners make the bedside decisions, and each facility has a monthly pharmacist review. We add a pharmacist on site, and a view across every facility.
A ChorusRx Clinical Pharmacist on the care team, reviewing with the nurse practitioner and attending physician at the visit, reconciling at readmission and following up on every recommendation. The monthly review continues, and we work from its reports.
Reconcile medications at every handoff and review the high-risk additions in the first days back (anticoagulants, opioids, insulin, sedatives), then hand it to the NP.
Score every resident's whole regimen, flag the combinations, review the highest-risk residents and recommend alternatives to the NP or attending physician.
Facility-level medication-risk reporting that lines up with the metrics your partners are paid on, so the plan and its facilities look at the same numbers.
Where we plug in
Your care managers already run the Model of Care. We add a Clinical Pharmacist to the care team and aim the medication work at the measures that count.
Find the late and lapsed fills, ask why, and take the answer to the prescriber or care manager: a side effect, a regimen that is too complex, a plan of care that changed.
Pharmacist reviews of the highest-risk members, documented in the plan's record in a form that supports the measure.
Score every member's regimen, flag the combinations, review the highest-risk members and recommend alternatives to the prescriber.
Deliver the annual review for eligible members and coordinate with your care managers so that no member is reviewed twice for the same purpose.
Built around your conditions
Your members enroll because of a condition, so the medication work should follow it. Each cohort gets its own measures, its own review and its own report.
What you are held to
What a pharmacist does
Reviews stopped and late fills and regimens that have not kept pace with the member, and sends recommendations to the prescriber.
What you are held to
What a pharmacist does
Reconciles medications after every discharge and checks whether the member's therapy is complete, with recommendations to the prescriber.
What you are held to
What a pharmacist does
Reviews adherence and statin and antiplatelet choices. Where a prescriber has a pending decision and a guideline exists, adds PGx for clopidogrel, statins or warfarin.5
Why ChorusRx
We are not a generic medication therapy management vendor adapting to special needs plans. Our model was built around frail, multi-chronic older adults, including people at the nursing-facility level of care.
PACE participants must be certified as needing nursing-facility level of care,7 the same acuity I-SNPs enroll. Our model was built and operated in full-risk programs serving frail, multi-chronic older adults, where a preventable admission has nowhere to hide.
Your clinicians make the care decisions and your own pharmacists may already review charts. Our Clinical Pharmacists work as part of the care team, in collaboration with the prescriber, and design the work to avoid reviewing the same member for the same purpose twice.
Claims and Part D data across your whole book show where anticholinergic and sedative burden, psychotropic use and risky transitions concentrate. Reporting maps to the measures you are held to and, for institutional plans, to the metrics your facility partners are paid on, not to activity counts.
PGx is core to how our Clinical Pharmacists work, applied where a published guideline says genotype changes a decision and read against the whole regimen. The science is established, and we know how to apply it.
ChorusRx offers value-based partnering agreements with performance guarantees and shares financial risk when outcomes are not achieved. Guarantees are underwritten to your population and negotiated case by case, once we have seen enough of your data to commit honestly.
Most insurers offering I-SNPs have fewer than about 2,500 I-SNP enrollees,6 a scale that can make it hard to justify a clinical pharmacy department. We are that layer, delivered alongside the team you already have.
A Clinical Pharmacist role in the interdisciplinary care team, documented in the Model of Care and the care plan, without replacing your health risk assessment, your care managers or your enrollment processes.
Reports by diabetes, heart failure, cardiovascular and lung cohorts against the Part D and HEDIS measures that apply to them, so your condition programs and your quality team look at the same numbers.
Institutional plans get a facility-level view, D-SNPs get work that sits inside the Model of Care and the integration rules, and C-SNPs get reporting by condition cohort. Choose your plan type above to see which.
The economics
Part D drug cost, and the share plans carry
After a member's $2,400 out of pocket, who pays the next drug dollar?9
What your Star Rating is worth in payment10
Bring your Part D data and we will size the opportunity with you before you commit.
What plans are measured on
Star Ratings are calculated at the contract level, and CMS excludes I-SNP enrollees from the Health Outcomes Survey (HOS) and institutionalized residents from the member experience survey (Consumer Assessment of Healthcare Providers and Systems, CAHPS). Several HEDIS measures also exclude I-SNP enrollees and long-term residents aged 66 and older.4, 14 MedPAC staff call Star Ratings a poor fit for I-SNPs.15 What remains is a short list of SNP-specific, transition and Part D measures, plus the contractual measures your facility partners are paid on.
| What you are held to | Type | The medication mechanism | What ChorusRx does about it |
|---|---|---|---|
| SNP Model of Care (reviewed by the National Committee for Quality Assurance, NCQA, approved for one to three years by score) | Regulatory | The Model of Care requires an interdisciplinary care team, individualized care plans and a quality program whose measures can draw on medication management and on medication reconciliation at care transitions.2 | A Clinical Pharmacist role inside the interdisciplinary team, medication goals documented in the care plan, and measure-level reporting your Model of Care quality section can use. Model of Care changes can be filed for NCQA review in the off-cycle windows.16 |
| Care for Older Adults: Medication Review | Star | A SNP-only measure of whether a documented medication review took place for enrollees 66 and older.4 | Pharmacist reviews documented in the plan's record in a form that supports the measure. |
| Plan All-Cause Readmissions and Transitions of Care | Star | Readmission carries triple weight in the Part C ratings, and the Transitions of Care measure includes medication reconciliation after discharge. The technical notes show no I-SNP exclusion for either.4 | Hospital-to-facility medication reconciliation, with pharmacist review of high-risk additions such as anticoagulants, opioids, insulin and sedatives in the first days back, handed to the NP and attending physician. |
| Part D adherence (diabetes, renin-angiotensin system [RAS] antagonists, statins) and Statin Use in Persons with Diabetes | Star (Part D) | Calculated from dispensing records. The three adherence measures are triple-weighted and adjust for inpatient stays and Medicare-covered skilled-nursing stays.4 In a facility where staff give the doses, the failure modes differ from the community: orders not carried across a transition, or therapy continued after goals of care have changed. | Review of whether each therapy still fits the resident's goals and was carried across the transition, with recommendations routed to the prescriber. |
| Anticholinergic burden and opioid–benzodiazepine co-use (Poly-ACH and COB) | Star (Part D, new) | Both measures joined the Part D Star Ratings for 2027.4 Cumulative anticholinergic exposure raises the risk of falls and delirium, and the American Geriatrics Society (AGS) Beers Criteria, which apply to institutional settings, flag it.17 | Whole-regimen anticholinergic and sedative burden scoring across every enrolled resident, then pharmacist review of those flagged, with recommendations to the prescriber. |
| Part D medication therapy management (MTM) comprehensive medication review (CMR) | Part D, returns 2029 | Plans must offer an annual CMR to MTM-enrolled members, including long-term care residents. The CMR completion rate is display-only now and returns as a Star measure in the 2029 ratings.3, 4 | Delivery of CMRs and targeted reviews across the I-SNP book, coordinated with consultant pharmacist reviews so a resident is not reviewed twice for the same purpose. |
| Facility incentive contracts | Contract | MedPAC's interviews found facilities in I-SNP networks are commonly paid capitation plus incentives tied to quality metrics and/or overall spending, often as shared savings; one chain cited falls with major injury, polypharmacy and hospitalizations as examples.6 | Facility-level medication-risk reporting that lines up with the metrics your partners are paid on, so the plan and its facilities look at the same numbers. |
| Part D plan liability | Financial | Under the redesigned benefit, plan sponsors typically pay 60% of catastrophic-phase drug costs.9 Therapy that is duplicative, unnecessary or high-risk for a given resident is a cost as well as a safety issue. | Identification of that therapy in your Part D data, sized with you. |
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What D-SNPs are measured on
Every measure you are held to has a lever on our side.
| What you are held to | Type | The medication mechanism | What ChorusRx does about it |
|---|---|---|---|
| SNP Model of Care and health risk assessment | Regulatory | An NCQA-approved Model of Care (up to three years by score), an HRA within 90 days (before or after) of enrollment and every year, and an individualized care plan built with an interdisciplinary care team; HRA results must be addressed in the care plan.2 | A Clinical Pharmacist role inside the interdisciplinary team and medication goals documented in the care plan. We support your HRA and care plan; we do not replace them. Model of Care changes can be filed for NCQA review in the off-cycle windows.16 |
| Part D adherence (diabetes, RAS antagonists, statins) and Statin Use in Persons with Diabetes | Star (Part D) | Calculated from dispensing records. Each adherence measure is triple-weighted; Statin Use in Persons with Diabetes carries a weight of 1.4 | Outreach on stopped or late fills with a pharmacist's read on why, such as regimen complexity, side effects or a changed plan of care, routed to the prescriber or care manager. |
| Care for Older Adults: Medication Review | Star, SNP-only | The numerator needs a medication review by a prescribing practitioner or a clinical pharmacist, plus a medication list, for enrollees 66 and older. CMS collects it only from SNPs.4 | Pharmacist reviews documented in the plan's record in a form that supports the measure. |
| Anticholinergic burden and opioid–benzodiazepine co-use (Poly-ACH and COB) | Star (Part D, new) | Both joined the Part D Star Ratings for 2027, each with a weight of 1.4 | Whole-regimen anticholinergic and sedative burden scoring across enrolled members, then pharmacist review of those flagged, with recommendations to the prescriber. |
| Part D MTM comprehensive medication review (CMR) | Part D, returns 2029 | The completion rate is display-only now and returns as a Star measure in the 2029 ratings.4 In a study of community-dwelling beneficiaries 66 and older, completion among members the plans defined as eligible rose from 10.2% in 2013 to 35.8% in 2020. Dual-Medicaid enrollees' completion rose faster after 2016 but stayed below that of members with neither Medicaid nor the low-income subsidy.18 | CMRs and targeted reviews delivered to eligible members, coordinated with your care managers so a member is not reviewed twice for the same purpose. |
| Plan All-Cause Readmissions and Transitions of Care | Star | Readmission is triple-weighted; Transitions of Care carries a weight of 1 and includes medication reconciliation after discharge.4 | Medication reconciliation with pharmacist review of high-risk additions in the first days after discharge, shared with the care manager and prescriber. |
| Part D plan liability | Financial | Under the redesigned benefit, plan sponsors typically pay 60% of catastrophic-phase drug costs.9 Therapy that is duplicative, unnecessary or high-risk for a given member is a cost as well as a safety issue. | Identification of that therapy in your Part D data, sized with you. |
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What C-SNPs are measured on
Every measure you are held to has a lever on our side.
| What you are held to | Type | The medication mechanism | What ChorusRx does about it |
|---|---|---|---|
| SNP Model of Care (one-year NCQA approval for C-SNPs) | Regulatory | An interdisciplinary care team, an HRA within 90 days of enrollment and every year, and an individualized care plan; C-SNP approvals run one year, so the Model of Care returns for review annually.2 | A Clinical Pharmacist role inside the interdisciplinary team, written into the Model of Care at your next submission, with condition-level medication goals in the care plan. We support your care management; we do not replace it. |
| Part D adherence (diabetes, RAS antagonists, statins) and Statin Use in Persons with Diabetes | Star (Part D) | Calculated from dispensing records. Each adherence measure is triple-weighted; Statin Use in Persons with Diabetes carries a weight of 1.4 These are the classes your members take most. | Outreach on stopped or late fills with a pharmacist's read on why, such as side effects, regimen complexity or an unresolved clinical concern, routed to the prescriber or care manager. |
| Condition measures: diabetes blood sugar control, kidney health evaluation, controlling blood pressure, statin therapy for cardiovascular disease | Star (Part C) | Intermediate-outcome and process measures that depend on the regimen working.4 | Pharmacist review of members off target, such as regimens not intensified or therapy missing for a documented indication, with recommendations to the prescriber. |
| Care for Older Adults: Medication Review | Star, SNP-only | The numerator needs a medication review by a prescribing practitioner or a clinical pharmacist, plus a medication list, for enrollees 66 and older. CMS collects it only from SNPs.4 | Pharmacist reviews documented in the plan's record in a form that supports the measure. |
| Anticholinergic burden and opioid–benzodiazepine co-use (Poly-ACH and COB) | Star (Part D, new) | Both joined the Part D Star Ratings for 2027, each with a weight of 1.4 | Whole-regimen anticholinergic and sedative burden scoring across enrolled members, then pharmacist review of those flagged. |
| Part D MTM comprehensive medication review (CMR) | Part D, returns 2029 | A sponsor's MTM program must enroll members who have multiple chronic diseases (no more than three required), take multiple Part D drugs (no more than eight) and are likely to incur covered costs above CMS's threshold ($1,340 in 2027), plus at-risk beneficiaries. The ten core conditions include heart failure, diabetes, dyslipidemia, hypertension and respiratory disease.3 The CMR completion rate is display-only now and returns as a Star measure in 2029.4 | CMRs and targeted reviews organized by condition cohort, coordinated with your care managers so a member is not reviewed twice for the same purpose. |
| Plan All-Cause Readmissions and Transitions of Care | Star | Readmission is triple-weighted; Transitions of Care carries a weight of 1 and includes medication reconciliation after discharge.4 | Medication reconciliation with pharmacist review of high-risk additions in the first days after discharge, shared with the care manager and prescriber. |
| Part D plan liability | Financial | Under the redesigned benefit, plan sponsors typically pay 60% of catastrophic-phase drug costs.9 Therapy that is duplicative, unnecessary or high-risk for a given member is a cost as well as a safety issue. | Identification of that therapy in your Part D data, sized with you. |
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Where a vendor fits
Most I-SNPs already have a pharmacist reviewing charts and a clinician at the bedside. The question is what a third party adds that those two do not.
| Capability | Facility consultant pharmacist | Plan NP team | Part D MTM program | ChorusRx |
|---|---|---|---|---|
| Monthly drug regimen review of each resident | Required by federal rule | At visits, case by case | CMR at least annually for enrolled members | Complements the required review rather than repeating it |
| View across every facility in the plan | One facility | The facilities each NP covers | Plan-wide, claims-based | Plan-wide, with facility-level drill-down |
| Whole-regimen anticholinergic and sedative burden scoring | Varies by pharmacist | Varies by clinician | Varies by program | Yes, across every enrolled resident |
| Pharmacogenomic testing and interpretation | Not required; availability varies | Not routine | Typically a separate benefit, if covered | Targeted, where a drug decision is pending |
| Recommendations to the prescriber | Reports to the attending physician, who documents a response | Acts at the visit | Faxed or portal recommendations | Collaboration with the NP or attending physician; formal agreements only where your structure supports them |
| Dispensing and packaging | Long-term care pharmacy dispenses under Part D short-cycle rules | Not applicable | Not applicable | Only where fulfillment is the gap, such as community-based members |
| Reported against the measures you are held to | Facility quality program | Varies | Plan-reported | Yes, at measure level |
| Vendor shares financial risk on outcomes | No | No | No | Performance guarantees, negotiated case by case |
Notes: consultant pharmacist requirements are from the federal long-term care regulation;1 Part D short-cycle dispensing and MTM requirements are from the Part D rules and CMS guidance.3 Cells marked "varies" reflect differences between programs and people, not a judgment of any of them.
Where the dollars sit
I-SNP bids sit closer to the CMS benchmark than other plan types do, which leaves a smaller rebate to spend on benefits: 6% of benchmark in MedPAC's 2025 data, versus 15% for conventional Medicare Advantage (MA) plans and 14% for dual-eligible special needs plans (D-SNPs).6 MedPAC reads the gap as either higher costs or less competitive pressure. For a sponsor, either reading raises the value of levers inside the clinical model, medication risk among them.
Part D adds its own pressure. Under the redesigned benefit the annual out-of-pocket threshold is $2,400 in 2027, up from $2,000 in 2025, and plans typically pay 60% of catastrophic-phase drug costs.9 Federal rules also require an MA contract to spend at least 85% of revenue on care and quality improvement or remit the difference.11
MedPAC analysis of 2025 bid data.6 Shows the size of the gap, not its cause; MedPAC notes higher bids may reflect higher costs or less competitive pressure.
The differentiator
We test where a genotype changes the decision, and a pharmacist reads each result against the member's whole regimen.
Illustrative: for a CYP2C19 poor metabolizer, the Clinical Pharmacogenetics Implementation Consortium (CPIC) advises considering a lower citalopram or escitalopram dose or a different antidepressant.19
In one U.S. nursing home, 13 of 17 genotyped residents (76.5%) had at least one major or moderate drug–gene interaction.20 In Denmark, 84.3% of 141 residents used a drug with a published PGx dosing guideline (a drug-use review, without genotyping).21 An Ontario program in four nursing homes identified 114 drug-therapy problems among 90 residents.22
CPIC publishes genotype-based guidance for SSRI antidepressants such as citalopram, escitalopram and sertraline, tricyclics, codeine and tramadol, clopidogrel, proton pump inhibitors, statins and warfarin.19
Genotype is only part of the picture. Interacting drugs can change how a member metabolizes a medication, a shift called phenoconversion: researchers found 280 phenoconversion events among 100 participants in the Program of All-Inclusive Care for the Elderly (PACE).23 Reading a result against the whole regimen, and deciding what to do with it alongside the prescriber, is clinical work a test report alone does not do.
Genotype guidance is best developed for antidepressants, tricyclics, codeine and tramadol, and proton pump inhibitors.19 Those are common drugs in behavioral health and pain regimens, and pharmacogenomics tells the prescriber which ones a member will handle well.
Guidelines cover clopidogrel (CYP2C19), statins and warfarin, three drugs central to cardiovascular care.5 We test where a prescriber has a pending decision and a guideline recommendation, and a pharmacist reads each result against the whole regimen.
Option A · The plan-level program
ChorusRx runs the medication program end to end: risk stratification from your claims and Part D data, Clinical Pharmacist review in collaboration with your NPs and attending physicians, targeted PGx where a drug decision is pending, and measure-level reporting by cohort (and by facility, for institutional plans), with performance guarantees negotiated case by case.
For plans, especially smaller or provider-sponsored plans, that cannot staff a clinical pharmacy team of their own.
Option B · If you already have a program
Already working with consultant pharmacists, an MTM vendor, a pharmacy benefit manager or your own clinical pharmacists? Keep them. ChorusRx supplies PGx testing, interpretation and decision support that flows into their process.
Testing is targeted and decision-triggered. We review with you how it is covered under your plan's policy.
Size the opportunity
I-SNP bids average $2,749 per member per month.6 A Kentucky Medicare program that paired pharmacogenomics with pharmacist management saved $218.34 per member per month, about 8% of that.24 Slide to see what it could mean across your enrollment.
Your enrollment across all facilities. The median I-SNP contract has about 900 members, a quarter have fewer than 500, and nearly nine in ten have fewer than 2,500.25
The Kentucky program saved $218.34 per member per month, about 8% of the average I-SNP bid. Set it to what you would count as a win.
What those savings are worth, per year
per member per month
Where the pharmacist's time goes, at national averages
An illustration of scale from the average I-SNP bid. Your own claims give the exact figure, and we size it with you.
Size the opportunity
D-SNP bids average $1,427 per member per month.6 A Kentucky Medicare Advantage program that paired pharmacogenomics with pharmacist management saved $218.34 per member per month.24 Slide to see what a share of that could mean across your enrollment.
Your enrollment in the contract. The median D-SNP contract has about 6,000 members; a quarter have fewer than 1,500 and a quarter more than 18,900.25
The Kentucky program saved about 7% to 8% of medical cost (our arithmetic from the study's figures). Set it to what you would count as a win.24
What those savings are worth, per year
per member per month
An illustration of scale from the average D-SNP bid (2025, the latest published by plan type). Your own claims give the exact figure, and we size it with you.
Size the opportunity
C-SNP bids run about 74% of benchmark,13 which on 2026 Medicare cost levels is roughly $975 per member per month (our estimate).29 A Kentucky Medicare Advantage program that paired pharmacogenomics with pharmacist management saved $218.34 per member per month.24 Slide to see what a share of that could mean across your enrollment.
Your enrollment in the contract. The median C-SNP contract has about 3,900 members; a quarter have fewer than 1,200 and a quarter more than 12,400.25
The Kentucky program saved about 7% to 8% of medical cost (our arithmetic from the study's figures). Set it to what you would count as a win.24
What those savings are worth, per year
per member per month
An illustration of scale from an estimated C-SNP bid; MedPAC does not publish a dollar figure by plan type for C-SNPs. Your own claims give the exact figure, and we size it with you.
How it runs
We do not need a long integration project before producing something useful. Risk stratification runs off the claims and enrollment data a plan already holds, so the first ranked work list can exist within weeks.
Now – December 31, 2026
Data use agreement, enrollment roster, a facility or provider list where relevant, and medical and Part D claims. Conversations with your clinical and pharmacy leads to agree who reviews what. If you want a pharmacist role documented in your Model of Care, the off-cycle window for changes, open to D-SNPs and I-SNPs, runs through December 31.16If you want a pharmacist role documented in your Model of Care, your next annual submission is the natural point, because C-SNP approvals run one year at a time.2
Q1 2027 · First wave
A ranked medication-risk cohort, pharmacist review of the highest-risk members in collaboration with the prescriber, transition reconciliation for hospital returns, and PGx testing where a drug decision is pending.
Mid-2027 · Plan-year 2028 bids
Monthly cohort refresh, facility- or cohort-level reporting, and the first two quarters of process data on anticholinergic and sedative burden, psychotropic use and transitions in hand for bid planning. By statute, bids are due on the first Monday in June, which in 2027 is June 7.30
2028 – 2029
Reporting continues against Poly-ACH and opioid–benzodiazepine measures already in the Star Ratings, and against the MTM completion measure that returns in the 2029 ratings.4 We will adapt the reporting to whatever CMS decides on special needs plans.
The proof
Gene-drug effects are established, published guidelines tell prescribers what to do about them, and the results are in.
25%fewer
Genotype-guided prescribing lowered clinically relevant adverse drug reactions from 28.6% to 21.5% in a randomized trial of 6,944 patients across seven countries.31
>50%fewer
PGx testing plus pharmacist review cut 60-day rehospitalizations in older home-health patients, from 0.70 to 0.33 per patient, in a randomized trial.32
$5,024
Per participant per year in 19 PACE organizations using structured medication risk mitigation, serving people who need a nursing-facility level of care.33
14.9%fewer
Medicare retirees aged 65 and older in a pharmacogenomics-enriched pharmacist program also had $218.34 lower medical cost per member per month (5,288 members, 32 months).24
7
SSRIs, tricyclics, codeine and tramadol, clopidogrel, proton pump inhibitors, statins and warfarin all have genotype-based guidance from the Clinical Pharmacogenetics Implementation Consortium.19
280
Researchers found 280 phenoconversion events, where one drug changes how a gene behaves, among 100 PACE participants. A test report alone cannot see that.23
0.39
Across 17 trials, pharmacist-led multidisciplinary reviews of older adults improved medication appropriateness (odds ratio 0.39) and adherence (risk ratio 1.14).34
0.67
Lower all-cause hospitalization with pharmacist care in heart failure, across 11 randomized trials and 3,576 patients (odds ratio 0.67).35
−0.53
Lower hemoglobin A1c with pharmacist-led care in type 2 diabetes, across 10 randomized trials (standardized mean difference −0.53).36
0.43
Fewer exacerbation-related hospital admissions with pharmacist-led management in COPD (risk ratio 0.43).37
Our founder, Calvin H. Knowlton, co-authored the PACE pharmacogenomics research cited in note 23 and has spent his career building medication-safety programs for frail, multi-chronic older adults. We will walk you through client results under NDA.
Questions SNP sponsors ask
No. We work with them. The facility or plan processes you already run stay as they are, we work from the information those teams produce and from your claims and Part D data, and we design the work so that a member is not reviewed twice for the same purpose. Where fulfillment itself is the gap, such as community-based members who need packaging organized by time of administration, we can provide pharmacy management including Precision Compliance Packaging.
Yes, for the drug decisions where it matters. Published guidelines cover the commonly used drugs, and in a randomized trial of 6,944 patients a 12-gene panel with guideline-based prescribing lowered clinically relevant adverse drug reactions from 28.6% to 21.5%. We test where a genotype would change a decision, not everyone, and a pharmacist interprets each result against the member's whole regimen because interacting drugs can change how a gene behaves.
A Clinical Pharmacist reads each member's whole regimen together: interactions, anticholinergic and sedative burden, duplicate therapy and drugs that may no longer be needed. The prescriber receives the reason and an alternative, such as a dose change or deprescribing a drug, and accepts, modifies or declines. We recommend. Your prescriber decides.
To start: the enrollment roster and medical and Part D claims, under a data use agreement, plus a facility or provider list where relevant. Optional but valuable: medication lists or electronic medication administration record exports for the highest-risk members. You receive a ranked medication-risk cohort, member-level recommendations routed to the prescriber or care manager, and plan-level reporting mapped to the measures you are held to rather than activity counts. Please do not send protected health information through this website; clinical data exchange happens under a signed agreement.
Commercial terms are negotiated per client. Engagements are commonly structured as a per-member-per-month fee, a shared-savings arrangement, or a hybrid with performance guarantees attached. Testing is targeted rather than universal, and how it is funded depends on your plan's coverage policy and the commercial arrangement; we model the options against your population before you commit.
Yes. We offer value-based partnering agreements with performance guarantees and share financial risk where outcomes are not achieved. We will discuss specific guarantee structures once we have seen enough of your data to underwrite them.
Review volume and medication-risk measures such as anticholinergic and sedative burden can move within the first 60 to 90 days. Claims-based utilization and Star Ratings measures follow as claims run out and the measurement year closes. We report leading indicators monthly, so you see the program working long before settlement data arrives.
ChorusRx contracts with the plan or its sponsor as a vendor and clinical service partner. We do not enroll members, market to beneficiaries or bill Medicare for your enrollees. Arrangements involving facilities or provider groups, incentive payments and data sharing should be reviewed by your own counsel and compliance team, and we will support that review with whatever documentation they need.
Start with whoever is accountable for the plan's clinical program: the chief medical officer or clinical director, together with Part D pharmacy and quality leaders. In provider-sponsored plans that is often the same leadership team that operates the nursing facilities. Facility directors of nursing, medical directors and consultant pharmacists should join early, because they decide whether recommendations are acted on and because the plan's contracts determine our access to residents. The form on this page asks which type of organization you are so that we route the first call correctly.
A pharmacist on site, and a view across every facility. We can place a Clinical Pharmacist at the facility, on the care team beside your nurse practitioners (NPs) and attending physicians, reviewing at the visit, reconciling when a resident returns from the hospital and following up on every recommendation. The facility pharmacist's monthly review, which federal rules already require, continues as it is, and we work from its reports. Across the plan we add whole-regimen risk scoring for every facility, targeted pharmacogenomic testing where a drug decision is pending, and reporting against the measures you are held to.
No. The monthly drug regimen review, the dispensing pharmacy and the facility's own processes stay as they are. We work from the consultant pharmacist's irregularity reports and the plan's claims and Part D data, and we avoid reviewing the same resident for the same purpose twice. Where fulfillment itself is the gap, such as community-based members in an institutional-equivalent plan, we can provide pharmacy management including Precision Compliance Packaging organized by time of administration.
Fewer high-risk medications, therapy matched to each resident's genetics where it matters, and a documented decision for every recommendation, reported facility by facility against the measures you and your partners are held to. Your nurse practitioners already keep residents out of the hospital; we keep them off the wrong medications.
Yes. The Centers for Medicare & Medicaid Services (CMS) asked for comment on special needs plan growth in its 2027 rulemaking. A plan that can show what its medication program did, facility by facility, with a documented decision behind every recommendation, is ready for whatever comes next.
Start with the parent organization's leaders who own the plan's medication and quality results: Part D and pharmacy, Star Ratings and quality, and the Medicare clinical and Model of Care lead. Where the plan is paired with a Medicaid managed care plan under the same parent, add that plan's clinical and pharmacy leadership and whoever runs dual-eligible integration. The form on this page asks which one you are so that we route the first call correctly.
Fewer inappropriate and high-risk medications, better adherence, and medication work documented in a form that supports the measures you are held to, including the triple-weighted adherence measures and the medication review measure that only special needs plans report. Pharmacist-led reviews of older adults have improved medication appropriateness and adherence across 17 randomized trials.
Beginning in 2027 a dual-eligible special needs plan's new enrollment is tied to the members of an affiliated Medicaid managed care plan where the same organization holds both, which puts the parent organization at the table. We do not change your health risk assessment, enrollment or Medicaid contracting. We work inside the care team, share what we find with your care managers, and report against the Medicare measures you are held to. Have your own counsel review how any vendor arrangement fits your state Medicaid agency contract.
No. Part D plans must offer an annual comprehensive medication review to members enrolled in their medication therapy management (MTM) program, and the completion rate returns as a Star measure in 2029. We can deliver those reviews or work alongside whoever does, and we coordinate so a member is not reviewed twice for the same purpose.
Start with the Part D and pharmacy leader, the Star Ratings and quality owner, and the special needs plan or Medicare product leader who owns the Model of Care and care management. Add your medical director and the leads of any condition-specific programs such as diabetes or heart failure. The form on this page asks which one you are so that we route the first call correctly.
Yes. Meta-analyses of randomized trials show lower hospitalization with pharmacist care in heart failure across 11 trials, lower hemoglobin A1c in type 2 diabetes across 10 trials, and fewer exacerbation-related admissions in chronic obstructive pulmonary disease. We organize the program by condition cohort so each one gets its own measures, its own review and its own report.
Published guidelines cover all three. For clopidogrel the guideline advises avoiding it in poor metabolizers of the cytochrome P450 2C19 (CYP2C19) enzyme, and avoiding standard-dose therapy in intermediate metabolizers, after acute coronary syndrome or a stent. We test where a prescriber has a pending decision and a guideline recommendation, and a pharmacist reads each result against the member's whole regimen.
Yes. The Centers for Medicare & Medicaid Services (CMS) noted rapid growth in chronic condition special needs plans in its 2027 rulemaking and asked for comment on possible requirements. A plan that can document what its medication program does, by condition, is ready for whatever comes next.
Next step
A working session with a ChorusRx Clinical Pharmacist, not a capabilities deck. Bring your enrollment, your provider or facility mix and how medication work is organized today, and we will map medication risk against the measures you are held to.
We reply within one business day.
Notes 33 and 23 come from research conducted at CareKinesis/Tabula Rasa HealthCare, our founder Calvin H. Knowlton's prior company, in the PACE population ChorusRx serves today; notes 24 and 32 describe programs run by other organizations whose authors include their developers. Results vary by plan. Program rules, payment policies and Star Ratings measure sets are set by CMS and change; verify all parameters against current CMS guidance.
