Payer PolicyActive
Zilretta (triamcinolone acetonide extended-release inject susp)
EVICORE-MEDICAL_DRUG-F0D9F23B
EviCore by Evernorth
Effective: November 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered only as a single 32 mg intra‑articular Zilretta injection for management of knee osteoarthritis; non‑knee or non‑intra‑articular uses, repeat doses, and prior Zilretta recipients are excluded. Approval requires radiologic confirmation of knee OA, documentation of inadequate response to a prior intra‑articular corticosteroid injection, proof the patient has not previously received Zilretta, and supporting clinical records.
Coverage Criteria Preview
Key requirements from the full policy
"Approval duration: 1 dose."
Sign up to see full coverage criteria, indications, and limitations.