Study Links Medicare AI Prior Authorization Pilot to Service Declines

A research letter published Oct. 26 in JAMA, from University of Minnesota and Brown University researchers, found that Medicare's WISeR pilot was associated with notable drops in targeted services in participating states during its first six months. Epidural steroid injections fell about 15% and other targeted services fell nearly 20% relative to trends in non-participating states, with the largest reductions occurring right after launch and tapering in the second quarter. Services with delayed WISeR implementation showed no significant change, serving as a control. The pilot, which applies AI-enabled prior authorization to traditional Medicare across six states over six years, continues despite pushback from Democratic lawmakers, and researchers say it remains unclear whether the forgone care was unnecessary or needed.