Gene Therapy Treatments for Beta Thalassemia - Medicare Advantage

Humana's Medicare Advantage policy covers one-time, single-dose gene therapies Casgevy (exagamglogene autotemcel) and Zynteglo (betibeglogene autotemcel) when specific clinical criteria are met: diagnosis of transfusion-dependent beta-thalassemia (Casgevy) or β-thalassemia requiring RBC transfusions (Zynteglo), required age ranges (Casgevy 12–65; Zynteglo 4–65), and absence of listed exclusions. Significant exclusions include pregnancy/desire to reproduce without contraception, hepatic or renal impairment, certain prior transplants (Casgevy), and specified positive viral serologies; all requests must be referred to Humana's Corporate Transplant Department and reviewed by a medical director.

"Casgevy (exagamglogene autotemcel) (J3392) one-time, single dose will be considered medically reasonable and necessary when the following indications are met: Absence of limitations; AND Individual..."