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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 Advantage, traditional Medicare has historically almost never required it.

That changed in January 2026 with the launch of a new federal pilot program. Called WISeR (Wasteful and Inappropriate Service Reduction), the program is a six-year pilot that requires prior authorization for a set of services considered vulnerable to fraud, waste and abuse in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The companies contracted to conduct the prior authorizations, which are mostly technology firms, are encouraged to use artificial intelligence in their prior authorization review processes. WISeR has been controversial, but until now there has been no evidence on its effects.

A new study from the University of Minnesota School of Public Health (SPH) and Brown University School of Public Health provides the first evidence about the pilot program. Using Epic Cosmos, a large electronic health record data set covering more than 300 million patient records nationwide, the researchers compared monthly use of WISeR-targeted services among traditional Medicare patients in the six participating states with use in all other states and the District of Columbia.

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