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Update to TMPPM Outpatient Drug Services Handbook for Sickle Cell Disease Gene Therapy

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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.

On June 1, 2025, the Texas Medicaid & Healthcare Partnership will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, section 6.113, “Sickle Cell Disease Gene Therapy,” to add language for the description and age requirement for lovotibeglogene autotemcel (Lyfgenia):

  • The client is 12 years of age or older at the expected time of gene therapy administration.
  • Lovotibeglogene autotemcel (Lyfgenia) is an autologous hematopoietic stem cell–based gene therapy indicated for the treatment of clients who are 12 years of age or older with sickle cell disease and a history of vaso-occlusive events with at least four vaso-occlusive events in the past 24 months or currently receiving chronic transfusion therapy for recurrent vaso-occlusive events.

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