MedicaidPrior AuthLow impact
MAB2025110702
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Transplant Surgery·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is updating prior authorization guidelines for Casgevy (exagamglogene autotemcel), a gene therapy for sickle cell disease and β-thalassemia. Key changes include removing the restriction on prior gene therapy recipients and adding a requirement for clinical stability for transplantation.
Action Required
By January 5, 2026: Billing and clinical teams should review updated prior authorization requirements for Casgevy prescriptions. Update any internal protocols to reflect that patients with prior gene therapy or stem cell transplants are now eligible, and ensure documentation includes prescriber assessment of clinical stability for transplantation. This primarily affects specialized transplant centers and hematology practices managing these rare conditions.