CommercialPrior AuthMedium impact
Triamcinolone Acetonide Injectable Suspension (Xipere®)
BCBS Tennessee·TN · Ophthalmology·Pharmacy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
BlueCross BlueShield of Tennessee is establishing a new coverage policy for Xipere® (Triamcinolone Acetonide Injectable Suspension) effective 9/30/2026. The drug is covered for macular edema associated with uveitis when prescribed by an ophthalmologist, requires prior authorization for 12-month periods, and is limited to a maximum dose of 4 mg per eye. All other indications are considered experimental/investigational and not covered.
Action Required
By September 30, 2026: Billing and prior authorization teams must implement coverage guidelines for Xipere® (Triamcinolone Acetonide Injectable Suspension). (1) Update prior authorization system to require 12-month authorization requests for macular edema associated with uveitis cases. (2) Configure system to verify: member has macular edema diagnosis with uveitis, infectious uveitis is excluded, and dose does not exceed 4 mg (0.1 mL) per eye. (3) Update denial reason codes to reject all other indications as experimental/investigational. (4) Notify ophthalmology practices that prescriptions must come from or be in consultation with an ophthalmologist. (5) Create prior auth checklist for front-desk and clinical staff. Claims submitted without proper authorization or for non-covered indications will be denied. This policy does not take effect until 9/30/2026—do not implement before that date.