What is Medicare's Prior Approval Pilot?

Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid Services (CMS) trials its much-discussed “ Wasteful and Inappropriate Service Reduction (WISeR) ” model.

The initiative, announced by the CMS in June, will require recipients of Original Medicare to receive prior approval before obtaining access to certain medical services. The pilot is only due to run in six states.

Medicare is health insurance for people aged 65 or older. Some younger people are eligible to receive the coverage if they have a disability, End-Stage Renal Disease (ESRD), or ALS. Almost 69 million Americans depend on the federally-funded program for their health insurance needs. As such, the impact of any changes to the program would likely be felt