Gene Therapy Treatments for Sickle Cell Disease - MEDICAID - FLORIDA

Humana Medicaid (FL) covers Casgevy (exa‑cel) and Lyfgenia (lovo‑cel) for treatment of sickle cell disease in members aged 12–65 who are candidates for autologous HSC transplant but lack a matched donor and who meet specific VOC/VOE frequency and event‑type criteria (Casgevy: ≥2 severe VOCs/year for 2 years; Lyfgenia: ≥4 VOEs/year for 2 years). Exclusions include certain infections (HBV/HCV/HIV as specified), pregnancy or unwillingness to use contraception, significant hepatic or renal impairment, prior HSC transplant (Casgevy), and other uses considered experimental/investigational. All requests must be referred to the Corporate Transplant Department and undergo medical director review, with supporting clinical documentation demonstrating event history, transplant candidacy and absence of contraindications.

"Casgevy (exagamglogene autotemcel) for treatment of sickle cell disease (SCD) in Humana members when all of the following are met: Absence of contraindications; AND individual is 12 through 65 year..."