Wakely Wire
January 10, 2025
New Insights
Whitepapers, briefs, press releases and more
Advancing Medication Adherence: Does Waiving Drug Copays Improve Medication Accessibility for Medicare Advantage Members?
As part of the CMS VBID program, Medicare Advantage Organizations (MAOs) had the opportunity to waive pharmacy copays for low-income (LI) beneficiaries. This whitepaper explores the impact this benefit had on part D quality measures, namely medication adherence to diabetes, hypertension, and hyperlipidemia drug routines. Our analysis found that removing copays on maintenance medications improved ... Read more
Summary of CMS’s CY2026 Proposed Rule
On November 26, 2024, the Centers for Medicare and Medicaid Services (CMS) released the “CY2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly”. The deadline to submit comments is January 27, 2025. The Proposed Rule includes numerous ... Read more
High Cost Members in Medicare Advantage Plans Strategies for Success
The management of high cost or complex condition members is a vital component of a successful Care Management program. These members make up a disproportionate level of costs, and losses, to Medicare Advantage Organizations (MAOs). On average, the costs associated with high-cost members are more than three times greater than the risk-adjusted revenue received from the Centers for ... Read more
Week in Washington 01/10/25
On the Hill Senate and House Republicans continue to discuss what should be included in the reconciliation bill. According to several outlets the House would like to pass a singular reconciliation bill that includes immigration and tax issues in April. From a health policy perspective, the key question is if there will be cuts to ... Read more
Newsworthy Findings
ACA Signups Set to Smash Record at 24M with Enrollment Continuing
The Biden administration attributed the growth to generous subsidies that are scheduled to expire at the end of this year.
New Rule Wipes Medical Debt from Consumer Credit Reports
The rule will remove an estimated $49 billion in medical bills from about 15 million Americans’ credit reports and bars lenders from using medical information in their lending decisions.
Healthcare Consumers Trust Insurer AI Tools, Want More Support: Survey
A survey by Pager Health and The Harris Poll reveals that two-thirds of insured Americans trust health insurers' AI copilots to accurately explain benefits, yet many feel insurers underutilize AI for personalization, wellness programs, and improved customer experience.
HHS Proposes New Cybersecurity Requirements as First Major HIPAA Update in 10 Years
HHS has proposed a rule updating HIPAA Security Standards to address modern cybersecurity threats, requiring stricter protections like encryption and multifactor authentication, while clarifying compliance expectations for covered entities and business associates.
Found Introducing Oral Dissolvable GLP-1 Tablet at Reduced Price
Weight management platform Found is today launching oral semaglutide dissolvable tablets for individuals looking for alternative ways to administer anti-obesity drugs. The new, compounded offering is notably cheaper than most injectable versions of GLP-1 drugs.
Bonus Article
Donated Christmas Trees Enrich the Habitats of Zoo Animals While Reducing Landfill Waste
Just for Fun
Math Joke:
What is a bird’s favorite type of math?
Prior Week
Q: Why was the equal sign so humble?
A: It knew it wasn’t less than or greater than anyone else!
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