Personal Story: A Sadder and WISeR Victim

As a healthcare activist, I began fighting the WISeR Pilot Program over eight months ago. Now I am one of the many victims of WISeR's privatizing of Traditional Medicare by imposing Prior Authorization (PA). Traditional Medicare has never required PA for common medical procedures. But as of 01/01/26, the WISeR pilot program began in AZ, TX, WA, OH, NJ, and OK. Each state contracts with a different private corporation (in AZ it’s Zyter, founded by a billionaire) financially incentivized to conduct AI review of prior authorizations. Note that these companies profit from every denial. To appeal denials, doctors must submit another request, which may be denied again. WISeR is causing unnecessary delays to standard care. If there are denials and appeals, treatment approval can take several months.

For two years, with no PA, Traditional Medicare covered steroid injections every 90 days for chronic pain. This allowed me to live a fairly normal life. Now, with extended delays on treatment, my chronic and severe back and leg pain is directly impacting my quality of life. It restricts my social interactions, bathing, dressing, food preparation, rehab program, exercise, chores and er-rands. Now, I have to complete most of these activities earlier in the day due to increasing pain and exhaustion.

Each time my doctor requests PA for an injection the current rule does not allow the request until 91 days after the prior injection so even if approved there is a delay. This is a clear violation of my treatment plan and has usurped my prior ability to receive timely injections every three months.

My doctor at The Pain Institute of Southern Arizona (PISA) is excellent. His practice has been forced to create an entire department devoted exclusively to getting PA for steroid injections. He and numerous other medical professionals are taking steps to try to end this ordeal. WISeR has been in effect only 4+ months, and lawsuits have already been filed regarding its effects on patients and practitioners.

Do not underestimate the potential of this single procedure on the “WISeR HIT LIST". WISeR stands to increase the potential of not just increased pain and suffering for the thousands of seniors like myself trying to get steroid injections. Denials will also, undoubtedly, cause an increase in our national opioid crisis as people who are denied coverage or can’t afford to pay out of pocket desperately turn to opioids and other drugs for pain relief. A once common procedure easily scheduled every ninety days by myself directly with my doctor/clinic has turned into a complete nightmare.

While WISeR's alleged goal is cutting costs, in reality it's just passing the costs onto practitioners and patients. It is a thinly veiled attempt to have corporate control of Traditional Medicare just like it has successfully accomplished with Medicare Advantage plans. In other words, profit over patients. If WISeR

is not shut down, its stated goal is to increase the amount of procedures currently requiring prior authorization and then expanding it nationwide.