Medicare's prior-authorization pilot test led to an immediate drop in use of services
For many years, traditional Medicare has operated almost entirely without prior authorization, a requirement that clinicians obtain approval before certain services will be covered. The practice is controversial because it adds paperwork, outside review and other barriers that can delay or deny coverage for recommended treatment. While prior authorization is widely used by commercial insurers and…
Medicare's recent pilot program for prior authorization, called WISeR, has led to a notable decrease in the use of certain medical services, according to a new study. Traditionally, Medicare has not required prior authorization, which is a practice where clinicians must obtain approval before certain services are covered. This new six-year pilot program, launched in January 2026, applies to six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
The study, conducted by researchers from the University of Minnesota and Brown University, analyzed data from Epic Cosmos, a large electronic health record data set. The researchers found that, compared to states outside the pilot, traditional Medicare patients in the participating states experienced immediate reductions in the use of targeted services by 15% for epidural steroid injections and about 20% for other services.
However, over time, these reductions weakened. While the study provides the first evidence of WISeR's effects, it leaves unanswered questions about whether the reduced care was unnecessary or clinically needed. The researchers recommend further investigation into the lasting effects of the model and its impact on patient outcomes, clinician burden, and Medicare spending.
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