Changes in Service Use Following the Introduction of AI-Enabled Prior Authorization in Medicare
JAMA 10.1001/jama.2026.21230October 26, 2026 at 11:05 AM EDT
This study uses Epic Cosmos data to assess changes in use of medical services by Medicare recipients after the implementation of artificial intelligence–enabled prior authorization requirements under the Center for Medicare & Medicaid Innovation WISeR (Wasteful and Inappropriate Service Reduction) model.
Key Findings: The cross-sectional analysis suggests Medicare’s 2026 WISeR prior authorization pilot was associated with an immediate drop in use of targeted services in participating states. In the first 6 months after launch, traditional Medicare encounters for epidural steroid injections fell by 15.0% and other targeted services fell by 19.5% relative to baseline. Delayed-implementation services did not change. Decline was strongest early and appeared to attenuate over time, raising questions about how AI-enabled prior authorization may affect clinician burden and patient outcomes over the full 6-year model.
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