Does Medicare Cover Zilretta?
Fair Square Medicare

Does Medicare Cover Zilretta?

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By Daniel Petkevich

Nov 28, 2022

You've got coverage

No one should have to endure the pain of arthritis without appropriate treatment. For many Medicare beneficiaries, Zilretta is the best option to deal with the knee pain that comes with Osteoarthritis. Good news, Medicare offers coverage. But how are you covered? Let's find out.

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What is Osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It’s a degenerative joint disease that causes cartilage to thin and bones to rub together. Symptoms of OA can include the following:

  • Joint stiffness

  • Swelling

  • Pain

  • Decreased range of motion.

OA usually affects people over age 50, but it can occur at any age.

What is Zilretta and what are its benefits?

Zilretta (triamcinolone acetonide extended-release injectable suspension) is an FDA-approved nonsteroidal anti-inflammatory drug (NSAID) used to treat knee osteoarthritis pain. It works by slowly releasing the medicine into your joint, providing sustained pain relief for up to 12 weeks. Zilretta can be used as part of your OA treatment plan to reduce the need for opioid medications.

Does Medicare cover Zilretta?

Medicare Part B covers Zilretta when medically necessary and prescribed by a doctor. A doctor’s prescription is necessary because it must be administered by a qualified healthcare professional via injection. Medicare will cover 80 percent of the cost after you meet your Part B deductible. If you have a Medicare Supplement Plan, it may cover the remaining 20 percent. Talk to your doctor and insurance provider for more information on coverage and costs.

How to get Zilretta if you're covered by Medicare?

If you are covered by Medicare and have a prescription for Zilretta, you can get the medication from your pharmacy. Your doctor will need to provide your pharmacy with the information necessary to submit a claim to Medicare. Once approved, you may be asked to pay any applicable copays, coinsurance, or deductibles at the time of purchase. Your pharmacy may also offer payment plans to make it easier for you to get the medication you need.

It’s important to talk to your doctor and insurance provider about coverage and costs before starting any treatment plan. They can help you understand which treatments are covered by Medicare and if there are other options that might be right for you.

Takeaway

Medicare Part B covers Zilretta when prescribed by a doctor and medically necessary. Talk to your doctor and insurance provider about coverage and costs before starting any treatment plan. This content is for informational purposes only. If you have any questions about your Medicare plan, talk with an expert at Fair Square Medicare.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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