Hematology - Casgevy™

Casgevy is covered as a one-time (per‑lifetime) IV dose for sickle cell disease (patients ≥12 years with specified beta‑globin genotypes and ≥4 severe VOCs despite prior therapy) and for transfusion‑dependent beta‑thalassemia (patients 12–50 years meeting genotype and transfusion thresholds), and is excluded for patients with prior HSCT or prior gene therapy, active infection, advanced liver disease, certain malignancies/immunodeficiencies, severe cerebral vasculopathy (SCD), or concomitant Reblozyl use. Approval requires extensive documentation including genetic testing, infection screening, transfusion/iron‑overload history, specific hematologic thresholds (e.g., HbS <30% and total Hb ≤11 g/dL for SCD; Hb ≥11 g/dL for TDT at required timepoints), prescriber specialty, reproductive precautions, attestation that HSCT is appropriate with no available/willing HLA donor, and verification of a minimum 3×10^6 CD34+ cells/kg dose.

"Casgevy is indicated for the following uses: Sickle cell disease in patients 6gt;= 12 years of age with recurrent vaso-occlusive crises (VOCs)."