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AetnaCommercial · Prior Auth · Medical Policy · ENT (Ear, Nose & Throat)Medium impact

Zopapogene Imadenovec-drba (Papzimeos) (CPB 1090, reviewed 2026-06-19)

Effective date
Dec 5, 2025
Identified
Aug 19, 2026

Summary

Aetna's clinical policy bulletin covers zopapogene imadenovec-drba (Papzimeos), a subcutaneous immunotherapy for adults with recurrent respiratory papillomatosis, for commercial medical plans. Precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers a one-time course of 12 weeks (4 doses) medically necessary when the member meets all listed criteria, and considers all other indications experimental, investigational, or unproven.

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What to do

Action · 6 steps
01Billing team: Obtain precertification before Papzimeos (HCPCS J3404) is given to commercial members in applicable plan designs.
02Call (866) 752-7021 or fax (888) 267-3277; Statement of Medical Necessity precertification forms are listed under Specialty Pharmacy Precertification.
03Confirm the prescriber is an otolaryngologist or a specialist in the treatment of recurrent respiratory papillomatosis.
04Confirm the member has 3 or more debulking procedures to remove laryngotracheal papillomas in the 12 months before treatment, a pathology-confirmed papilloma diagnosis, documented HPV serotype 6 or 11, and a negative hepatitis B and hepatitis C serology test.
05Confirm the member has received no more than 4 doses and that Papzimeos is not used with other RRP medications such as bevacizumab or cidofovir.
06Document surgical debulking of visible papillomas before the initial administration, and again before the third and fourth administrations if papillomas are present.

Codes mentioned

96372J3404B97.7D14.1

Original notice

Zopapogene Imadenovec-drba (Papzimeos) (CPB 1090, reviewed 2026-06-19)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesENT (Ear, Nose & Throat)Code 96372Code J3404Code B97.7Code D14.1

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