Medicare AdvantagePrior AuthMedium impact
Gene Therapy Treatments for Beta Thalassemia - Medicare Advantage (Revised)
Humana·Hematology, Oncology, Transplant Surgery·Medicare Advantage
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new coverage criteria for two gene therapy treatments for beta thalassemia: Casgevy (J3392) and Zynteglo (J3393). Both require medical director review through the Corporate Transplant Department and have specific age and clinical requirements for coverage approval.
Action Required
Before December 1, 2025: Billing team must update system to flag J3392 and J3393 gene therapy codes for mandatory medical director review. All requests must be routed to Corporate Transplant Department at 1-866-421-5663 or transplant@humana.com. Update encounter forms to include age verification (12-65 for Casgevy, 4-65 for Zynteglo) and clinical criteria checklist. Claims without prior medical director approval will be denied.