MedicaidPrior AuthMedium impact
Xipere® (triamcinolone acetonide) (Revised)
Humana·KY, SC · Ophthalmology·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Humana's Xipere (triamcinolone acetonide) policy for Medicaid members in Kentucky and South Carolina was revised on July 22, 2026. This is a prior authorization requirement for the intraocular suspension used to treat macular edema associated with uveitis. The policy requires members to have a confirmed diagnosis of macular edema associated with uveitis to qualify for coverage.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for all Xipere (triamcinolone acetonide) claims for Kentucky and South Carolina Medicaid members. Update billing system to require prior auth submission before claim processing. Ensure that all requests include documentation of macular edema associated with uveitis diagnosis. For medically billed requests, staff should reference www.humana.com/PAL to obtain applicable medical and procedural coding information. Claims submitted without prior authorization will be denied.