2025-08-18 @ 00:00
Starting January 1, 2026, Traditional Medicare will introduce **prior authorization requirements** in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—as part of the new **Wasteful and Inappropriate Services Reduction (WISeR) Model**. This change, previously common mainly in Medicare Advantage plans, requires providers to obtain Medicare approval before delivering certain services, aiming to reduce fraud, unnecessary treatments, and healthcare costs while safeguarding patient safety. The WISeR Model focuses on 17 services that have shown vulnerability to waste and abuse. This initiative promises a more streamlined, technology-supported review process with faster decisions and increased transparency, ultimately improving care quality and cost-effectiveness for patients, providers, and insurers. Additionally, major health insurers are pledging to simplify prior authorization workflows, further reducing administrative burdens starting in 2026. Patients in affected states should prepare for this change, which balances protection against inappropriate care with some potential for procedural delays.