MedicaidPrior AuthMedium impact
Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)
Humana·OH · Orthopedics, Rheumatology, Sports Medicine +1 more·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Ohio is implementing a new prior authorization requirement for Zilretta (triamcinolone acetonide extended-release), an intra-articular injection for knee osteoarthritis. Coverage requires documented symptomatic knee OA, no prior Zilretta use in the same knee, and failure of two different short-acting intra-articular steroids. This is a brand-new policy effective March 1, 2026.
Action Required
By February 15, 2026: Billing team must configure prior authorization workflow in billing system for Zilretta claims from Humana Medicaid Ohio members. Providers must submit documentation of: (1) symptomatic knee OA diagnosis with treatment limited to knee, (2) confirmation no prior Zilretta in same knee, and (3) evidence of inadequate response to TWO different short-acting intra-articular steroids (e.g., triamcinolone AND methylprednisolone, or betamethasone AND dexamethasone). Update encounter forms and clinical templates to capture these requirements. Beginning March 1, 2026: All Zilretta claims for Ohio Medicaid members must include prior authorization approval before submission. Claims submitted without documented prior authorization will be denied by Humana.