Wakely Wire
New Insights
Whitepapers, briefs, press releases and more
2023 Supplemental Claims Impact
Supplemental claims increased risk scores by over 5% in the 2023 ACA individual market. A 5% increase can translate to approximately $15-$25 PMPM or $1.5 to $2.5 million dollars for a 10,000-member, 100,000-member month population. This 5% represents a continued year-over-year increase in supplemental claims impact. Health plans should understand their current risk score gaps, ... Read more
Week in Washington 08/29/24
Medicare Advantage Johnson & Johnson & 340B Johnson and Johnson announced this week that it would require hospitals in the federal 340B drug discount program to buy the drugs at full price starting in mid-October. Hospitals would then have to submit drug claims data to receive a rebate. HHS has signaled that J&Js proposed change ... Read more
Events & More
Unlocking Solutions in Medicaid, Medicare, and Marketplace
If you haven’t already registered, now is the perfect time to sign up for HMA’s event, Unlocking Solutions in Medicaid, Medicare, and Marketplace. In this short video, HMA Chief Executive Officer Chuck Milligan shares what makes this event different from other conferences.
Newsworthy Findings
Semaglutide Coverage for Weight Loss Could Cost Medicare Billions: Study
If all newly eligible patients received semaglutide, Medicare Part D spending could increase by $34 billion to $145 billion each year, according to new research.
J&J Plans Unilateral Reform to 340B Drug Discount Program
Johnson & Johnson informed hospitals last week that it would stop giving them upfront discounts on two of its medications eligible for a discount under 340B.
Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition
Federal officials drafted a plan in 2014 to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an “uproar” from the industry.
CMS has received 12K complaints of No Surprises noncompliance; won $1.7M in restitution
Federal regulators received more than 12,000 complaints that insurers and providers weren’t complying with the No Surprises Act, a law that was passed four years ago to include provisions preventing surprise medical billing.
Biden-Harris Administration Awards $100 Million to Navigators Who Will Help Millions of Americans — Especially in Underserved Communities — Sign Up for Health Coverage
The Biden-Harris Administration today continued its historic investment in health care coverage and the Affordable Care Act (ACA) by awarding a new round of $100 million to organizations vital to helping underserved communities, consumers, and small businesses find and enroll in quality, affordable health coverage.
Bonus Article
Newly Discovered Protein Stops DNA Damage and Even Repairs it – Pointing to a Cancer Vaccine
Just for Fun
Math Joke:
Why did students wear glasses during math class?
Prior Week
Q: The first number in a sequence is 2. Every subsequent number is the product of the previous number and the number of letters in its English name. What is the 3rd number in the sequence?
A: 18
Sign up for the
Wakely Wire,
our industry newsletter.
