Payer PolicyActive
Zilretta® (triamcinolone acetonide extended-release injectable suspension)
EVICORE-MEDICAL_DRUG-4C5180A7
EviCore by Evernorth
Effective: November 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only for intra‑articular management of knee osteoarthritis as a single 32 mg injection (no re‑treatment of a previously Zilretta‑treated knee and no coverage for other joints). Approval requires radiologic confirmation of knee OA, documentation of inadequate response to a prior intra‑articular corticosteroid, confirmation the knee has not previously received Zilretta, and records showing the single 32 mg intra‑articular knee injection.
Coverage Criteria Preview
Key requirements from the full policy
"Zilretta is indicated as an intra-articular injection for the management of osteoarthritis pain of the knee."
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