Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

The Digital Quality Future Is Now on the Calendar: ACOs Should Not Wait to Prepare

CMS Digital Quality Measurement Timeline (2027–2030): What ACOs Need to Know About FHIR-Based Quality Reporting CMS Has Put a Timeline on Digital Quality Measurement For the first time, CMS has outlined a potential roadmap for transitioning Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) to Fast Healthcare Interoperability Resources (FHIR)-based digital quality measurement (dQM). ... Continue reading

Continue reading

Emerging 2026 ACA Data: Enrollment Drops 12% as Relative Risk Rises 6.3%

New data show a smaller, higher-risk ACA individual market emerging after enhanced premium tax credits expired. In Wakely’s new white paper, 2026 Individual Market Risk Pool Considerations: Emerging Data on Marketplace Post Expiration of Enhanced Subsidies, early 2026 data indicate that Affordable Care Act (ACA) individual market enrollment declined 12.0% while normalized relative risk increased ... Continue reading

Continue reading

What Medicare Data Reveals About Oncology Spending Trends, Innovation, and Cost Forecasting

New Wakely analysis of seven years of Medicare claims data (2018–2024) shows oncology spending is shaped by therapeutic innovation, adoption cycles, biosimilars, and benefit channel dynamics—not price inflation alone. The paper introduces a new framework for forecasting oncology trend: Oncology Trend = Price + Adoption + Duration + Benefit Channel + Replacement This framework suggests ... Continue reading

Continue reading

Newsworthy Findings

Medicare Part D 2027 National Average Monthly Bid Amount Information

On July 28, 2026, the Centers for Medicare & Medicaid Services (CMS) released preliminary technical Medicare Part D bid information for contract year (CY) 2027 to help Part D plan sponsors finalize their Part D and Medicare Advantage (MA) offerings and prepare for Medicare Open Enrollment.

Read full article
Editor's Note
The national average monthly bid amount (NAMBA) is an enrollment-weighted average of all applicable Part D plan bids for basic Part D benefits, with weights based on the number of enrollees in each plan. The NAMBA for CY2027 will be $296.05. The base beneficiary premium will be $41.33, resulting in a national average direct subsidy amount of $254.72.

‘Back On Track’: Centene Swings To More Than $1B In Profit In Q2

Centene handily beat Wall Street’s expectations in the second quarter, as higher revenue from premiums and rate hikes for the managed care company’s plans shielded its bottom line from elevated medical costs.

Read full article
Editor's Note
Centene posted $53.6 billion in revenue, up 10% year over year, and $1.1 billion in profit in the quarter. That’s compared to a loss of $253 million the same time last year when Centene was caught off guard by higher spending — the insurer’s first quarterly loss in more than two years.

Humana To Exit More Medicare Advantage Plans In 2027

The insurer is laser-focused on reaching margin targets and will sacrifice some plans with lower returns next year to do so.

Read full article
Editor's Note
Humana is continuing to reduce its Medicare Advantage footprint as part of its strategy to achieve long-term margin targets. This year, the company exited three states and 194 counties. For next year, Humana plans to discontinue lower-return plans and concentrate on plans with stronger profitability, allowing it to maintain stable benefits and retain members in plans that better support its long-term goal of achieving 3% margins, according to the CEO.

Independent Pharmacies Hit Prime Therapeutics with Antitrust Suit Over Alleged Price Fixing

A group representing thousands of pharmacies has filed an antitrust suit against Prime Therapeutics, alleging that the company colluded with rival Express Scripts to fix prices.

Read full article
Editor's Note
The plaintiffs are seeking damages for alleged antitrust violations and breach of contract, while Prime denies the claims, arguing that its network strategy lowers prescription drug costs and generates billions in savings for patients and health plans.

CMS Ending Medicare Part D Subsidy Program

The Trump administration announced it will end a subsidy program aimed at keeping premiums low for Medicare Part D beneficiaries.

Read full article
Editor's Note
CMS announced it will end the Medicare Part D Premium Stabilization Demonstration after the 2026 plan year, eliminating the temporary subsidy program that was introduced in 2025 to help keep premiums low. The agency said plans now have enough experience with the redesigned Part D benefit to operate without the subsidies, and CMS Administrator Mehmet Oz criticized the program as an unnecessary taxpayer-funded bailout for insurers.

Bonus Article

Just for Fun

Math Joke:

Why was the function feeling depressed?

Prior Week

Q: Why are mathematicians great at parties?

A: They know how to integrate.

Sign up for the
Wakely Wire,

our industry newsletter.