Medicare AdvantagePrior AuthMedium impact
Xipere® (triamcinolone acetonide) (Revised)
Humana·KY, SC · Ophthalmology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Xipere (triamcinolone acetonide) prior authorization policy effective October 22, 2025, for Medicare and Medicaid (Kentucky and South Carolina). The policy requires prior authorization for this suprachoroidal injectable suspension used to treat macular edema associated with uveitis. The single clinical criterion is confirmation of macular edema associated with uveitis diagnosis. Approval duration is determined by plan year or clinical review for both initial and renewal requests.
Action Required
By October 22, 2025: Billing team must implement prior authorization requirements for all Xipere (triamcinolone acetonide) claims across Medicare Advantage and Medicaid (Kentucky and South Carolina) plans. Update billing system to flag Xipere claims for prior authorization submission before processing. Providers must document diagnosis of macular edema associated with uveitis on all Xipere requests. Contact Humana PAL (https://www.humana.com/PAL) to obtain applicable medical and procedural coding information for claim submission. Claims submitted without prior authorization will be denied. Verify this policy remains current before implementation by checking Humana's online policy portal, as printed versions become uncontrolled.