MedicaidPrior AuthLow impact
MAB2024070202
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Jul 15, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will require prior authorization for all Lyfgenia (lovotibeglogene autotemcel) prescriptions starting July 15, 2024. This gene therapy for sickle cell disease must be prescribed by specialists at qualified treatment centers and meet strict clinical criteria including specific genotypes and history of vaso-occlusive episodes.
Action Required
By July 15, 2024: Pharmacy staff and prescribing providers must obtain prior authorization before prescribing or dispensing Lyfgenia (lovotibeglogene autotemcel) for Pennsylvania Medicaid patients. Ensure prescriptions meet FDA-approved indications, are from qualified treatment centers, and include required clinical documentation for sickle cell disease patients with specific genotypes and vaso-occlusive episode history. Prior authorizations will be approved for 18-month periods.