PQA is celebrating its 20th year in 2026. In addition to special events at the 2026 PQA Annual Meeting in Baltimore, Md., May 12-14, PQA will recognize across the year the people, milestones and achievements that have defined the organization’s success. We also will look to the future and PQA’s continuing work to improve the quality of medication use.
Micah Cost, PharmD, MS, CAE, has served as PQA’s chief executive officer since January 2021. In this Q&A, he shares insights on PQA’s history, his tenure and what the future holds for PQA and quality.
You have served as PQA’s CEO for the last five years, one quarter of its history. Where has PQA had the greatest impact in your tenure?
Over the past 5 years, PQA has responded to the challenge of addressing complex medication-related issues. Claims-based measures are low hanging fruit, and a staple in the quality measurement industry, but PQA has intentionally focused on evaluating solutions to challenging issues related to oral anticancer medications, medication access, social determinants of health, pharmacy-level measurement, and medication management, among others.
Alongside the meaningful work, PQA has grown our staff and our expertise with intentionality and a focus on building for the future. The development of our team has been one of the most rewarding aspects of my time here at PQA.
You were involved in some of PQA’s early measure development work. What did that involve and how did that shape your view of PQA?
I was involved with PQA as a volunteer on workgroups dating back as early as 2010. PQA was in its early stages at that time, so it was rewarding to be a part of a unique alliance that brought together such a diverse set of stakeholders to do meaningful work to drive quality medication use. As a recently graduated pharmacist early in my career, I was honored to give my time and service to PQA because I believed in the mission and vision of the organization.
I can say with confidence that the diversity of stakeholders is one of the most important strengths of PQA, and we focus on protecting our consensus-based process and ensuring that we are inclusive of all voices in everything we do.
Thinking about PQA’s overall history, how would you describe its value and accomplishments for the U.S. health care system?
Most people are familiar with PQA’s medication adherence-related measures which are used in the Medicare Part D Star Ratings program. These measures are the most heavily weighted in the Star Ratings program, and CMS has shown that they have resulted in billions of dollars in costs avoided to the health care system.
What’s perhaps not as well known, but equally important, is our ongoing focus on measures related to medication safety, medication management, and appropriate use, in addition to medication adherence. These four focus areas are core to our work, and PQA continues to drive medication use quality in each of these areas.
PQA is a unique organization with its multi-stakeholder approach and narrow focus on quality medication use. What do you attribute to its enduring success?
Nonprofit organizations are truly unique and driven by the power of a strong mission and vision, a community with a shared commitment to accomplishing meaningful work, a spirit of service, and volunteers to contribute their time, expertise, and resources to the effort. PQA is a broad-based collective of organizations and individuals who are committed to the goals of better medication-related care, outcomes, and quality of life for all patients.
Much has been said about the people who have led, volunteered and worked for PQA over the last two decades. Who are the people who stand out to you as central to PQA’s achievements?
There are so many visionaries and supporters who have helped shape PQA over the past twenty years. There are truly too many people to list, from our board members to our volunteers and supporters, to our staff and contributors. I’m grateful for each organization and individual who has left their mark on the alliance in their own unique way.
With that said, the folks that immediately come to mind are the visionaries who stood together and launched PQA in 2006 alongside the Medicare Part D prescription drug program. My predecessor, Laura Cranston, was PQA’s founding CEO and our organization’s only employee for several years as the alliance began its work. Alongside Laura, there were champions at the Centers for Medicare and Medicaid Services (CMS), including Mark McClellan, Larry Kocot, Vikki Ahern, Michelle Ketcham, and Jeffrey Kelman, who were dedicated to ensuring that PQA was successful.
I’m also thankful for the members of our Board of Directors, and especially our Board chairs, for their leadership and strategic vision in shaping the alliance. And of course, there were organizations, like AHIP, pharmacy organizations, and life sciences, who helped to sustain our organization throughout our twenty years of success. It’s been an “all-hands-on-deck” approach to sustaining PQA over the past twenty years.
PQA will gather for its 20th Annual Meeting in Baltimore this year. How have PQA’s in-person gatherings shaped its work and success?
When I joined PQA, I talked to a few folks who knew PQA well, and they described the alliance as a “big tent” collaborative consisting of a diverse array of organizations and individuals. Our meetings bring together important traditional and non-traditional voices in medication use quality to address the most important issues facing our healthcare system.
With a unique focus on showcasing and amplifying partnerships and collaborations, PQA designs our programming in a way that ensures that the innovative models and tremendous work being done by our members is shared with our audience. Our meetings are also designed to make sure that our members have time to catch up and explore opportunities for partnerships and business collaborations.
PQA’s Board recently approved a five-year strategic plan to guide the organization through 2030. What is the greatest opportunity for PQA in the coming years?
There are a few opportunities for PQA in the next few years that come to mind. First, our organization has an opportunity to advance quality measure stewardship and enhance support for our member and stakeholder community through measure rate validation.
It is a process that assesses the accuracy, reliability and validity of how measures rates are calculated based on measure specifications. This is an initiative that our stakeholders have requested for some time now, and this program will provide us with the ability to support and guide users of PQA measures throughout their measure implementation process.
Second, we are committed to exploring measure concepts which go beyond the traditional claims-based structure. By utilizing expanded data sources, we can evaluate the quality of medication management services, pharmacy services, clinical outcomes and patient-reported outcomes. Barriers still remain to broadly using non-claims data, but companies, organizations and associations across health care are focused on addressing these infrastructure issues.
A third area where PQA is well positioned to advance medication use quality relates to pharmacy access. As our health system evolves and traditional models and centers of care shift, serious questions abound about the state of pharmacy access and its impact on patients, their ability to obtain medications and services, as well as the performance of the health care providers who serve them.
Beyond the current plan, what do you see as the long-term future of PQA and medication use quality?
When CMS issued the 2027 Medicare Advantage and Part D proposed rule last November, the agency said it aims to refocus the program on “clinical care, outcomes, and patient experience where there is meaningful variation in performance across contracts.” The goal is to focus our time and resources on care that improves health outcomes, and it presents a tremendous opportunity for PQA and everyone focused on quality improvement and quality measurement.
It is a long-term endeavor, and it requires the work and support of all health care stakeholders, but we can build the systems, infrastructure, measures, tools and resources that support and are responsive to these national goals. PQA is eager to play its part in realizing these goals.
PQA’s 20th anniversary celebrations are made possible in part by the generous support of Pfizer, Eli Lilly and Company, Humana and Centene. PQA does not endorse, recommend or favor any product, service or organization that is a sponsor.