Gene Therapy Treatments for Sickle Cell Disease - Medicare Advantage

Covers autologous hematopoietic stem cell (HSC)-based gene therapies for sickle cell disease (e.g., exagamglogene autotemcel/Casgevy, lovotibeglogene autotemcel/Lyfgenia) intended to increase fetal/normal hemoglobin and reduce vaso-occlusive crises. Coverage is limited to individuals aged 12 through 65 with a history of recurrent VOCs who are candidates for autologous HSC transplant but lack a matched donor, and is subject to Medicare "reasonable and necessary" criteria, medical director review (and referral to the Corporate Transplant Department).

"Inferred: Treatment of sickle cell disease (SCD) associated with abnormal hemoglobin S (HbS) — intended to address the underlying HbS pathology, reduce vaso-occlusive crises (VOCs), and prevent org..."

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