Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia

Aetna covers allogeneic hematopoietic cell transplantation for thalassemia major and sickle cell anemia in children and young adults (up to age 45) when members meet the transplanting institution’s written eligibility criteria; if no institutional criteria exist, thalassemia coverage requires a haploidentical-to-HLA-matched donor, and sickle cell coverage requires both a haploidentical-to-HLA-matched donor and either a history of stroke or documented increased risk of stroke/end-organ damage (e.g., recurrent acute chest syndrome, recurrent vaso‑occlusive crises, or RBC alloimmunization). Autologous HCT is experimental/investigational and not covered (CPT 38206, 38232, 38241), and requests for adults >45 years are referred to the National Medical Excellence unit for review.

"Note (from policy): Factors associated with increased risk of stroke or end-organ damage include recurrent chest syndrome, recurrent vaso-occlusive crises, and red blood cell alloimmunization on ch..."