Medicare WISeR pilot: services fell 15

In January 2026, the US federal government launched a pilot in traditional Medicare that requires advance approval for certain treatments. Researchers from the Brown University School of Public Health and the University of Minnesota School of Public Health report that use of the targeted services fell significantly in the pilot states during its first six months, according to a release published by EurekAlert on 4 November 2026. The findings appeared in a JAMA research letter dated 26 October 2026. eurekalert.org

What the pilot covers

The program is called the Wasteful and Inappropriate Service Reduction Model, or WISeR. It operates in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. It targets 41 types of medical services considered vulnerable to fraud, waste and abuse, with the aim of reducing unnecessary treatments and Medicare spending. eurekalert.org

Prior authorization was a major change for traditional Medicare, where doctors had rarely needed approval before providing treatment. For many health policy experts, this raised the question of whether patients would face new barriers to care. eurekalert.org

How the decline was measured

The team analyzed electronic health records from Epic Cosmos. They compared how often patients received targeted treatments in the six pilot states with the rest of the country during 2024, 2025 and the first six months of 2026. eurekalert.org

Patients in the pilot states received epidural steroid injections for back pain, the program's most frequently used service, 15% less often than expected from trends elsewhere. Use of the other targeted services, measured together, was nearly 20% lower. The declines were greatest in the first three months after launch. In the following three months, use stayed lower, but the gap between pilot states and the rest of the country narrowed. eurekalert.org

The authors say the data cannot show whether the care not received was needed. "The key question we can't yet answer is whether the care not received was wasteful or necessary," said lead author Hannah Neprash of the University of Minnesota. Co-author Dr. Michael Barnett of Brown University said the early results suggest doctors may be adapting rapidly to the new system. He added that it must be watched whether the extra work of prior authorization is justified by what might be a relatively small change in who gets care. eurekalert.org

The researchers note that further study is needed to determine whether the declines persist. It must also establish how the program affects patients, clinicians' workloads and Medicare spending over its six-year run. eurekalert.org

Medicare WISeR prior-authorization pilot linked to 15–20% drop in targeted services in six states

What the pilot covers

How the decline was measured

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