Medicare's AI-enabled prior authorization pilot cuts targeted services; judge blocks Medicaid frailty limit; mRNA RSV vaccine effective in veterans

• AI Oct 26, 2026
  Epidural steroid injections fall 15% under Medicare's AI-enabled prior authorization pilot in six states, JAMA letter finds
  Researchers from the University of Minnesota and Brown University used Epic Cosmos data to compare Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington with other states after the Wasteful and Inappropriate Service Reduction (WISeR) model began in January 2026, according to JAMA. Epidural steroid injections declined 15% and other targeted services about 20%, while control services showed no significant change, the University of Minnesota said. The epidural reduction fell from about 21% in the first quarter to about 9% in the second. The model's vendors are encouraged to use artificial intelligence in review.
  Sources: JAMA, University of Minnesota, Medical Daily
• Policy Oct 29, 2026
  Federal judge blocks CMS limit on Medicaid work requirement's medical frailty exemption, leaves work rule in place
  Federal Judge Richard G. Stearns ruled that the Centers for Medicare & Medicaid Services (CMS) "lacked authority to exclude any subset of individuals" within the medical frailty categories, in a suit by 25 states and the District of Columbia, according to Healio. A June addition had required beneficiaries to demonstrate that their condition significantly impairs their ability to comply. The order upholds the work requirement, which starts Jan. 1 for certain beneficiaries aged 19 to 64 and calls for 80 hours a month of qualifying activity. The American Medical Association (AMA) said the court rightly rejected the restriction.
  Sources: Healio, AMA
• Research Oct 28, 2026
  mRNA RSV vaccine shows 81.8% effectiveness against hospitalization but 28.6% against infection at 80 and older in veterans
  A target trial emulation in the Veterans Health Administration matched 74,926 vaccinated veterans aged 50 and older to 286,425 controls, enrolling from Oct. 1, 2025, to Jan. 31, 2026, according to JAMA Network Open. Estimated effectiveness of the mRNA-1345 vaccine was 60.3% (95% CI 49.0% to 70.4%) against any documented infection and 81.8% (95% CI 58.1% to 99.9%) against RSV-associated hospitalization. Effectiveness against infection fell from 82.9% at ages 50 to 59 to 28.6% (95% CI -12.0% to 60.4%) at 80 or older, a confidence interval that included zero.
  Source: JAMA Network Open
• AI Oct 30, 2026
  Using AI-drafted portal replies tied to 29.5% shorter turnaround, but tool adoption adds 8.6% to overall turnaround
  In a cohort study of 983,154 patient portal message responses from 1,542 clinicians at Columbia University Irving Medical Center, using an AI-generated draft was associated with a 29.5% reduction in turnaround time, according to JAMA Network Open. Adopting the tool was associated with an 8.6% increase in overall turnaround time (95% CI 4.6% to 12.9%). Tool use was not associated with an overall reduction in after-hours responding.
  Source: JAMA Network Open

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