CommercialCoverageMedium impact
Gene Therapy for Treatment of Sickle Cell Disease
Blue Cross & Blue Shield of Mississippi·MS · Hematology, Oncology, Pediatrics·Medical Policy
Effective date
Jan 15, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has established a new policy stating that gene therapy treatments Casgevy and Lyfgenia for sickle cell disease are considered not medically necessary due to insufficient evidence compared to other covered treatments. Both therapies will be denied unless prior authorization is obtained through BCBSMS PA review process.
Action Required
Immediately: Update billing system to flag HCPCS codes J3392 and J3394 as requiring prior authorization through BCBSMS PA review process before administration. Alert providers that these gene therapies for sickle cell disease are considered not medically necessary and claims will be denied without proper PA approval. Verify formulary coverage on patient's member ID before prescribing.