Traditional MedicarePrior AuthLow impact
Papzimeos™ (zopapogene imadenovec-drba)
Humana·FL, KY, SC · ENT (Ear, Nose & Throat), Pulmonology, Oncology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Papzimeos (zopapogene imadenovec-drba), a gene therapy for recurrent respiratory papillomatosis in adults. Prior authorization is now required for Medicare and Medicaid plans in Florida, Kentucky, and South Carolina, with specific criteria including biopsy confirmation, age 18+, and coordination with surgical procedures.
Action Required
By October 22, 2025: Billing team must update prior authorization processes for Papzimeos (zopapogene imadenovec-drba) subcutaneous suspension for Medicare and Medicaid patients in Florida, Kentucky, and South Carolina. Ensure documentation includes biopsy confirmation of recurrent respiratory papillomatosis, patient age verification (18+), and coordination with surgical debulking procedures. Claims will require prior approval before administration.