CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Papzimeos (zopapogene imadenovec-drba)
Blue Cross & Blue Shield of Mississippi·MS · ENT (Ear, Nose & Throat), Pulmonology, Oncology·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
The State and School Employees' Health Insurance Plan has classified Papzimeos (zopapogene imadenovec-drba), a new HPV immunotherapy for recurrent respiratory papillomatosis, as not medically necessary. Claims for this drug and its administration will be denied as other covered treatment options are available.
Action Required
By April 1, 2026: Billing team must update system to flag HCPCS codes J3404 and J3590 as non-covered for State and School Employees' Health Insurance Plan members when used for Papzimeos treatment. Advise providers that claims for this drug and its administration will be denied, and alternative covered treatments should be considered for recurrent respiratory papillomatosis patients.