Gene Therapy Treatments for Beta Thalassemia - MEDICAID - SOUTH CAROLINA
HUMANA-GENE-THERAPY-TREATMENTS-FOR-BETA-THALASSEMIA-SC-MEDICAID
This Humana Medicaid (South Carolina) policy covers one‑time gene therapy with exagamglogene autotemcel (Casgevy) and betibeglogene autotemcel (Zynteglo) for treatment of transfusion‑dependent β‑thalassemia (TDT). Coverage is limited to product‑specific criteria: Casgevy for ages 12–65 with ≥10 packed RBC transfusions/year (past 2 years), hydroxyurea failure/intolerance and candidate for allogeneic HCT but lacking a matched donor; Zynteglo for ages 4–65 with ≥8 transfusions/year (past 2 years), Karnofsky/Lansky ≥80, single lifetime dose given at a certified center, suitability for autologous stem‑cell collection/manufacture, and medical director review/authorization.
"No specific documentation requirements (medical records, lab results, or clinical notes) are stated in this document chunk."
Sign up to see full coverage criteria, indications, and limitations.