Payer PolicyActive
Zilretta® (triamcinolone acetonide extended-release injectable suspension)
EVICORE-MEDICAL_DRUG-802A57DF
EviCore by Evernorth
Effective: November 1, 2025
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only as a single 32 mg intra‑articular injection for osteoarthritis pain of the knee (use in other joints and re‑treatment with Zilretta are excluded). Coverage requires radiologic confirmation of knee OA, documentation of a prior intra‑articular corticosteroid injection with an inadequate response, confirmation the knee has not previously received Zilretta, and supporting clinical notes.
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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