Medicare AdvantagePrior AuthHigh impact
Papzimeos™ (zopapogene imadenovec-drba)
Humana·FL, KY, SC · Genetics, Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
Papzimeos™ (zopapogene imadenovec-drba) is a new gene therapy requiring prior authorization for Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Billing teams must implement prior authorization procedures before claims submission to prevent denials.
Action Required
Immediately: Billing team must contact Humana to obtain the specific CPT/HCPCS code for Papzimeos™ administration and configure the billing system to require prior authorization for this drug across Medicare and Medicaid plans in FL, KY, and SC. Update the prior authorization request form in your EMR or paper-based system to include Papzimeos™. Train providers and billing staff that all Papzimeos™ claims must have prior authorization approval BEFORE submission. Without prior authorization documentation attached, claims will be denied. Contact the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56d8cb) to download the full policy for complete coverage criteria, medical necessity requirements, and authorization processes.