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Update to “Sickle Cell Disease Gene Therapy Coverage Information”

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

This is an update to an article titled “Sickle Cell Disease Gene Therapy Coverage Information,” which was published on this website on January 10, 2025.

Prior authorization may be approved for a duration of 12 months for exagamglogene autotemcel (Casgevy) procedure code J3392 and lovotibeglogene autotemcel (Lyfgenia) procedure code J3394.

Additional language for vaso-occlusive events will be added to the following requirement for initial authorization for lovotibeglogene autotemcel (Lyfgenia):

The client has a history of vaso-occlusive events, with at least four vaso-occlusive events in the past 24 months, or is currently receiving chronic transfusion therapy for recurrent vaso-occlusive events.

For more information, call the TMHP Contact Center at 800-925-9126.