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

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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

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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

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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.

Registration opens this Spring!

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.

Learn more and register

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.

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Editor's Note
The executive orders could significantly reshape healthcare access, affordability, and policy priorities, with potential implications for public health, drug pricing, and insurance coverage.

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.

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Editor's Note
If Congress does not adopt MedPAC’s recommendations, hospitals may continue to face financial strain, potentially impacting Medicare beneficiaries’ access to care and the stability of safety-net funding.

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.

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Editor's Note
The CMS selected Semaglutide as well as other diabetes drugs, respiratory therapies and cancer treatments among the 15 drugs for the second round of drug negotiations set up by the Inflation Reduction Act.

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.

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Editor's Note
These fraud cases include crimes such as providers who billed federal healthcare programs for medically unnecessary services, engaged in referral kickback schemes, and used upcoding to receive higher reimbursements.

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.

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Editor's Note
Home-based care has a trend of lowering the total cost of care, which can lead to increasing interest in those services from the government. For example, Hospice saves Medicare about $3.5 billion for patients in their end of life.

Bonus Article

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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