Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

Week in Washington 07/25/24

On The Campaign Trail CMS Flu Vaccine Axios reported that demand for flu vaccine shots has declined over the past two years, including among the elderly.  2023 to 2024 flu season saw about 63.2 million US adults get a vaccine shot compared to 69.5 million the prior flu season. Flu related hospitalizations and death increased ... Read more

Read more

Events & More

Don't wait! Discount ends July 31 for HMA's Fall Conference!

Dive into the payer side of the industry at HMA’s 7th annual Fall Conference:

Payer Innovation: Scaling Innovations, Tools, and Technology to Achieve Whole Person Care

Our panelists are tackling the big issues head on: adapting to the demands for value-based care; harnessing tools they have and exploring those still needed to deliver, measure, and improve on quality at the person level; and shaping the future of integrated care for Medicare and Medicaid dually eligible individuals. They’re also navigating through the headwinds of increased scrutiny on payment; charting a course for the transformative potential of AI in healthcare, and other critical topics on the horizon. Attendees will gain insights into how plans are adapting to new regulatory frameworks and what plans need and expect from potential partnerships to address health disparities. 

Learn more and register

Newsworthy Findings

PBMs Battle Bipartisan Scrutiny as Lawmakers Eye Industry Reform

Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.

Read full article
Editor's Note
The PBMs maintain they lower drug costs for their clients, but they’ve found themselves at the center of mounting public criticism. The Federal Trade Commission is reportedly preparing to sue CVS Caremark, Express Scripts and Optum Rx over how they negotiate drugs with pharmaceutical manufacturers. The lawsuit follows the FTC’s report earlier this month about how PBMs’ business practices contribute to higher costs and less consumer choice.

Pharmacy Group, Providers Sue Change Healthcare After Cyberattack

The National Community Pharmacists Association and dozens of providers argue UnitedHealth-owned Change didn’t have adequate cybersecurity protections and caused them financial losses.

Read full article
Editor's Note
The cyberattack on Change in late February caused upheaval across the nation’s healthcare system, delaying payments to providers, prescription fulfillment, prior authorization requests and eligibility checks. The latest lawsuit seeks class-action status and argues the disruptions from the cyberattack are still ongoing.

CMS: Insurers to Make $10.3B in 2023 Risk Adjustment Payments

Risk adjustment state transfers as a percent of premiums declined from 2022, according to the report. This trend is likely driven by shifts in the risk pools, according to CMS, which are likely impacted by ongoing insurer expansion into new regions.

Read full article
Editor's Note
The report outlines that this risk transfer can help offset challenges in the Medicare and Medicaid markets for payers like Centene.

HHS Announces Major New AI, Cybersecurity and IT Reorganization

Oversight for healthcare technology, data and AI policy and strategy will be grouped under the renamed ASTP/ONC, while the 405(d) cybersecurity program will move to the Administration for Strategic Preparedness and Response.

Read full article
Editor's Note
The aim of this restructuring is to capitalize on new opportunities across those fast-evolving technologies, according to HHS, and will redistribute responsibility across three existing agencies.

What the CMS 2025 PFS Proposed Rule Means for Virtual Care

The 2025 PFS proposed rule extends existing virtual care payment rules and introduces new codes for digital therapeutics, highlighting virtual care's lasting role in healthcare.

Read full article
Editor's Note
CMS is proposing creating an additional three HCPCS codes and six G codes for treatment devices surrounding mental health. If included in the final rule, these new codes could mark a shift in the digital therapeutics industry.

Bonus Article

Just for Fun

Math Joke:

Why was the triangle the MVP of the basketball team?

Prior Week

Q: What is a math teacher’s favorite snake?
A: Pi-thon

Sign up for the
Wakely Wire,

our industry newsletter.