CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - 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
State and School Employees' Health Insurance Plan has established a new policy deeming gene therapy treatments Casgevy and Lyfgenia for sickle cell disease as not medically necessary. Claims for these treatments and their administration will be denied due to insufficient evidence of clinical benefit compared to other covered treatments.
Action Required
Immediately: Billing team must flag HCPCS codes J3392 (Casgevy) and J3394 (Lyfgenia) as non-covered for State and School Employee Health Plan members. Update billing system to automatically deny or hold these claims for manual review. Inform providers that these gene therapies and their administration services will not be reimbursed by this plan.