MedicaidPrior AuthLow impact
MAB2024070203
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 prescriptions of Casgevy (exagamglogene autotemcel), a gene therapy for sickle cell disease and β-thalassemia, effective July 15, 2024. Prior authorization requests will be approved for 18 months and must include specific clinical documentation requirements.
Action Required
By July 15, 2024: Providers prescribing Casgevy (exagamglogene autotemcel) must obtain prior authorization through Pennsylvania Medicaid before dispensing. Ensure prescriptions include FDA-approved indications, patient age appropriateness, correct dosing, specialist prescriber at authorized treatment center, and specific clinical criteria for sickle cell disease or β-thalassemia patients. Update workflow to submit prior authorization requests with required clinical documentation.