8 things to know about the Medicare prior authorization pilot program

Becker's Healthcare November 12, 2025
Elizabeth Casolo

The Wasteful and Inappropriate Service Reduction initiative from CMS will take effect next year, adding prior authorization requirements to traditional Medicare. Providers in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma will pilot the new protocol.

Here are eight things to know about the state of prior authorization and the upcoming program:

1. CMS said Cohere Health, Genzeon Corp., Humata Health, Innovaccer, Virtix Health and Zyter will participate as vendors in the pilot.
2. In November, six House Democrats introduced legislation to shut down the pilot.
3. The AHA has been outspoken about delaying the program by at least six months. An Oct. 23 letter to CMS from the group outlined several recommendations for the initiative, such as establishing guardrails for AI...

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