Wakely Wire
New Insights
Whitepapers, briefs, press releases and more
Summary of Draft CY 2026 Part D Redesign Program Instructions
On January 10, 2025, the Centers for Medicare and Medicaid Services released draft instructions on the CY2026 Part D Redesign. These instructions contain detailed descriptions and guidance to all Inflation Reduction Act changes newly in place for CY2026, including benefit design changes, adjustments to MLR calculations, meaningful difference testing, creditable coverage, non-calendar EGWPs, the selected ... Read more
Impact of Final 2026 Federal Actuarial Value Calculator Updates
The 2026 Federal Actuarial Value Calculator (AVC) was released on October 16, 2024. The new version is methodologically similar to prior AVC models after two years in a row of substantial data updates and methodological changes. That does not mean the impacts will be mild though, as inflation continues to drive high trend which will ... Read more
Week in Washington 01/23/25
On The Hill House Republicans continued to make progress on a potential reconciliation bill. A reconciliation bill generally only target tax and spending provisions and would only need a simple majority to pass in the Senate. Politico posted the latest document that was being circulated. Included in the bill were: As a next step House ... Read more
Events & More
Adapting for Success in a Changing Healthcare Landscape
New for 2025, HMA is excited to be hosting our annual conference in New Orleans! Join us October 14-16, 2025 in the Big Easy for informative and engaging sessions about the changing world of healthcare. Join HMA along with healthcare C-suite leaders and decision makers from across the U.S. to develop strategies for success in a transitioning – and opportunity rich – healthcare and adjacent-sector landscape.
Wakely Webinar: Summary & Impactions of 2026 Medicare Advantage Advance Notice & Draft Part D Redesign Instructions
The Centers for Medicare & Medicaid Services (CMS) recently released the 2026 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment and other key financial and regulatory requirements for 2026. During this webinar, Wakely consultants will provide an overview of the proposed changes, with an emphasis on the likely impact that the new rates and policies will have on Medicare Advantage bids, membership growth, quality and strategy. Speakers will also touch on the important items from the Draft CY 2026 Part D Redesign Instructions, released on the same day as the Advance Notice.
Newsworthy Findings
What Trump's First Day Orders Mean for Healthcare: Ditched Drug Models, Pauses on Rules and Hiring
President Donald Trump’s second-term executive orders initiated sweeping changes to healthcare, including regulatory freezes, the rescission of Biden-era drug pricing models, and the rollback of reproductive health and insurance-related policies.
MedPAC Votes to Recommend Hospital Pay Increases for 2026
The Medicare Payment Advisory Commission (MedPAC) will recommend a 2026 Medicare pay rate increase for hospitals, alongside a $4 billion boost to safety-net funding, aiming to balance beneficiary access, hospital sustainability, and cost control.
Medicare Will Negotiate Novo’s GLP-1 Drug Price. Here’s What that Means for Ozempic, Wegovy.
Novo sells semaglutide as Ozempic, Rybelsus and Wegovy. The CMS will treat the different forms as a single product in price talks.
False Claims Settlements in Healthcare Total $1.7B in 2024
Healthcare fraud investigations accounted for more than half of the Department of Justice’s settlements and judgments in 2024, which totaled north of $2.9 billion.
Cutting Costs: How a Republican Administration Could Impact Hospice
New presidential administrations always come with questions about what the future will hold, but Republicans’ focus on cost-cutting could bode well for home-based care — if providers can get their message across.
Bonus Article
FDA Finally Bans Red Dye No.3 from Food, Drinks and Medicines in US–Following Cancer Link
Just for Fun
Math Joke:
Why did the student eat his math homework?
Prior Week
Q: Why did the tangent line break up with the curve?
A: This relationship is just too limiting!
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