Medicare Prior Authorization: How the WISeR Pilot Will Affect Medicare Patients in 2026

Starting in January 2026, some people on Original Medicare will face new rules about getting care.

The Centers for Medicare & Medicaid Services (CMS) is launching a pilot program, known as the Wasteful and Inappropriate Service Reduction (WISeR) model, to test a new way of handling prior authorization.

This will be the first time prior authorization applies to Traditional Medicare, not just Medicare Advantage.

The program will last six years, ending in 2031, and run in six states.

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What Is the Medicare WISeR Pilot?

The WISeR model will use artificial intelligence (AI) and private contractors to review requests for certain medical services.

CMS says the goal is to:

• Cut down on fraud, waste, and abuse in Medicare.

• Prevent spending on services with little or no medical benefit.

• Speed up the prior authorization process compared to current systems.

According to the Medicare Payment Advisory Commission, Medicare spent up to $5.8 billion in 2022 on unnecessary or inappropriate services.

What Services Will Be Affected?

CMS says the pilot will target procedures considered at risk for overuse. Examples include:

• Skin and tissue substitutes

• Electrical nerve stimulator implants

• Knee arthroscopy for osteoarthritis

Some services will not be included in the pilot. These are:

• Emergency care

• Inpatient-only services

• Any services that would endanger patients if delayed

Which States Will Be Impacted?

The WISeR model will roll out in six states:

• Washington

• New Jersey

• Oklahoma

• Ohio

• Texas

• Arizona

Different private contractors will oversee the pilot in each region.

Why Is It Controversial?

Not everyone supports the new Medicare pilot.

Democratic lawmakers and patient advocacy groups argue that:

• Prior authorization could delay care for seniors.

• AI-driven reviews may replace doctors’ judgment.

• Private companies may be incentivized to deny care to save money.

In August 2025, 17 Democratic lawmakers wrote to CMS Administrator Mehmet Oz (Dr. Oz), warning that the WISeR model would “limit beneficiaries’ access to care” and create “perverse incentives to put profit over patients.”

Republicans, including Health and Human Services Secretary Robert Kennedy Jr., had previously promised to “fix the broken prior authorization system,” raising questions about why this program is being expanded now.

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