MedicaidPrior AuthMedium impact
Zilretta® (triamcinolone acetonide extended-release injectable suspension) (New)
Humana·LA · Orthopedics, Rheumatology, Pain Management +1 more·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid has implemented a new prior authorization policy for Zilretta (triamcinolone acetonide extended-release injectable suspension), effective March 1, 2026. The policy requires prior authorization for intra-articular knee osteoarthritis injections and establishes three mandatory approval criteria: documented symptomatic knee OA, no prior Zilretta use in the same knee, and failure of two different short-acting intra-articular steroids. Billing teams must implement prior authorization workflows immediately to avoid claim denials.
Action Required
By February 15, 2026: Billing and prior authorization teams must update systems to flag all Zilretta (triamcinolone acetonide extended-release injectable suspension) requests for Louisiana Medicaid members as requiring prior authorization. Providers must verify and document: (1) symptomatic osteoarthritis of the knee limited to knee joint only, (2) no prior Zilretta administration in the same knee, and (3) documented failure of treatment with TWO different short-acting intra-articular steroids (e.g., triamcinolone AND methylprednisolone, or betamethasone AND dexamethasone). Update prior authorization request forms to require these three criteria. Update provider communication materials explaining that Zilretta cannot be repeat-dosed in the same knee per FDA label. Train front desk and clinical staff that all Zilretta claims for Louisiana Medicaid will be denied without prior authorization approval. Coordinate with orthopedic and rheumatology providers to ensure proper documentation of prior steroid injection history at time of service.