MedicaidPrior AuthMedium impact
Gene Therapy Treatments for Sickle Cell Disease - MEDICAID - KENTUCKY (Revised)
Humana·KY · Hematology, Pediatrics, Transplant Surgery·Medicaid
Effective date
Jan 13, 2026
We identified it
Jun 24, 2026
Summary
Humana Kentucky Medicaid has established new coverage criteria for two gene therapy treatments for sickle cell disease: Casgevy and Lyfgenia. Both treatments require medical director review and specific clinical criteria including age 12+, genetic testing, hydroxyurea failure/intolerance, and documented vaso-occlusive crises.
Action Required
By January 13, 2026: Billing team must coordinate with Corporate Transplant Department (1-866-421-5663, transplant@humana.com) for all gene therapy requests for sickle cell disease. Ensure providers document all required criteria including genetic testing, hydroxyurea history, age verification, and vaso-occlusive crisis frequency before submitting authorization requests. Authorization approvals are valid for 1 year only.