New CMS Star Measures Targeting
High-Risk Medication Combinations

Concurrent Use of Opioids and Benzodiazepines

Combining opioids and benzodiazepines can increase the risk of overdose because both can cause sedation and suppress breathing and impair cognitive functions. Research shows that people who use these medications concurrently are at higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency and dying of an overdose.

Description
The measure looks at the percentage of patient ages 18 and older (as of Jan. 1, 2025) with concurrent use of prescription opioids and benzodiazepines.

Compliance
To be compliant with this measure, concurrent use of opioids and benzodiazepines must be less than 30 cumulative overlapping days during 2025.*

Best practices

• Always check the Louisiana Prescription Monitoring Program to ensure patients are not being prescribed controlled substances by other providers.
• Limit prescribing opioid pain medicines with benzodiazepines or other central nervous system (CNS) depressants only to patients for whom alternative treatment options are inadequate.
• If opioids and benzodiazepines are prescribed together, limit the dosages and duration of each medication to the minimum possible while achieving the desired clinical effect.

Learn more about this measure, including common brand names for these medications and ways to support patients.

Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults

Medications with anticholinergic (ACH) action are widely prescribed in older adults because of potential clinical benefits. However, ACH medications can have serious, adverse effects on both CNS and the peripheral nervous system (PNS). CNS effects include dysfunction in different cognitive domains, cognitive impairment, an acceleration of neurodegenerative processes, the appearance of psychotic or confusional symptoms, and functionality disturbances. PNS effects include dry mouth, urinary retention, constipation and paralytic ileus, increased heart rate, and blurred vision, among others.

Description
The measure looks at the percentage of patients ages 65 and older (as of Jan. 1, 2025) with concurrent use of two or more unique (different active ingredient) ACH medications during 2025.

Compliance
To be compliant with this measure, concurrent use of two or more ACH medications must be less than 30 cumulative overlapping days during 2025.*

Best practices

• Identify patients taking two or more ACH medications.
• Regularly re-evaluate the efficacy and risks of ACH medications, especially for treatment periods longer than three months because of the potential risk of irreversible cognitive effects.
• When prescribing ACH medications to older adults, prioritize medications with fewer ACH effects and high effectiveness at the target site.

Learn more about this measure, including common ACH medication names and ways to support patients.

*A lower rate indicates better performance.

Sources: Optum Quality Quick Tip, Concurrent Use of Opioids and Benzodiazepines (COB) MY2025, 3/2025; Optum Quality Quick Tip, Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) MY2025, 2/2025