MedicaidPrior AuthMedium impact
Papzimeos™ (zopapogene imadenovec-drba) (New)
Humana·OH · Oncology·Medicaid
We identified it
Jul 21, 2026
Summary
Humana Ohio Medicaid has issued a new prior authorization policy for Papzimeos™ (zopapogene imadenovec-drba), a gene therapy treatment. The billing team must implement prior authorization requirements for this drug effective immediately to avoid claim denials for Ohio Medicaid members.
Action Required
Immediately: Billing team must implement prior authorization requirements for Papzimeos™ (zopapogene imadenovec-drba) in the billing system for all Ohio Medicaid claims. Contact the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5847f6) to obtain complete policy details including specific HCPCS code, prior auth process, and medical necessity criteria. Update claim submission workflows to require prior auth approval before billing. Notify providers and pharmacy staff of the new requirement. Claims submitted without prior authorization will be denied by Humana Ohio Medicaid.