Zilretta® (triamcinolone acetonide extended-release injectable suspension) (Revised)

By January 28, 2026: Billing and clinical teams must implement prior authorization requirements for all Zilretta claims submitted to Humana Indiana Medicaid. (1) Update billing system to flag all Zilretta requests for mandatory prior auth review. (2) Providers must document in patient records: confirmation of symptomatic knee OA, verification that patient has NOT received prior Zilretta in the affected knee, and evidence of inadequate response to TWO different short-acting intra-articular steroids (examples: triamcinolone AND methylprednisolone, or betamethasone AND dexamethasone). (3) Include this documentation with all prior auth submissions to Humana. (4) Set approval duration reminders for 6-month intervals for both initial and renewal requests. Claims submitted without prior authorization or missing required documentation will be denied. Front desk and clinical staff should be aware that repeat Zilretta administration in the same knee is not covered per FDA label.