Health Affairs October 9, 2025
In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model. While Medicare already uses prior authorization in limited situations, WISeR is poised to expand this scope.
The model will engage technology companies to implement technology-assisted prior authorization with the goals of safeguarding patients from unnecessary or potentially harmful care; reducing waste in the Medicare program; and supporting clinicians by improving the speed, accuracy, and consistency of coverage determinations. WISeR is intended to target a set of services that can be overused, have variable evidence of clinical benefit, or possess potential associations with fraud, waste, or abuse (such as skin and tissue substitutes, electrical...
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