Medicare AdvantagePrior AuthMedium impact
Papzimeos™ (zopapogene imadenovec-drba) (Revised)
Humana·FL, KY, SC · ENT (Ear, Nose & Throat), Pulmonology, Infectious Disease·Medicaid
Effective date
Oct 22, 2025
We identified it
Jul 21, 2026
Summary
Humana has updated its prior authorization policy for Papzimeos™ (zopapogene imadenovec-drba), an immunotherapy for recurrent respiratory papillomatosis (RRP). The policy requires prior authorization and mandates that patients meet four specific criteria: biopsy-confirmed RRP diagnosis, concurrent surgical debulking procedures, age 18+, and supporting documentation. Prior auth is denied if the patient has completed a previous treatment course.
Action Required
Before October 22, 2025: Billing and clinical teams must implement prior authorization requirements for Papzimeos administration. Specifically: (1) Update billing system to flag all Papzimeos claims for mandatory prior auth review; (2) Create clinical checklist requiring verification of: biopsy-confirmed RRP diagnosis, patient age ≥18 years, and documented surgical debulking coordination; (3) Instruct providers to submit supporting documentation (chart notes confirming diagnosis and surgical plan) with all prior auth requests; (4) Train front-desk and prior-auth staff to deny requests from patients with prior completed treatment courses; (5) Coordinate with surgical teams to ensure Papzimeos injections (4 doses over 12 weeks) are scheduled with surgical debulking before dose 1 and before doses 3 and 4. Failure to obtain prior authorization will result in claim denials. This applies to Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina plans only.