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Medicare AdvantagePrior AuthMedium impact

Papzimeos™ (zopapogene imadenovec-drba) (Revised)

Humana·FL, KY, SC · Ophthalmology, Genetics·Medicaid
Effective date
Not stated
We identified it
Jul 21, 2026
Days to comply
—

Summary

This is a revised Prior Authorization policy for Papzimeos™ (zopapogene imadenovec-drba), a gene therapy treatment. The policy applies to Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Your billing team must implement prior authorization requirements before submitting claims for this medication to avoid denials.

Action Required

Action needed
Immediately: Billing team and clinical staff must obtain prior authorization from Humana (Medicare and applicable state Medicaid plans) before administering or billing for Papzimeos™. Contact the plan at the authorization line and reference this revised policy. Update your EMR and billing system to flag any Papzimeos™ claims as requiring prior auth for affected plan members. Train front desk and clinical staff to verify coverage and obtain authorization before patient administration. Claims submitted without prior authorization will be denied and may result in patient balance liability.

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