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Independence Blue CrossCommercial · Administrative · Pharmacy · PA · Hematology, Oncology, Pharmacy +2 moreLow impact

08.02.14a, Casgevy™ (exagamglogene autotemcel)

Effective date
Jul 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued Policy 08.02.14a for Casgevy (exagamglogene autotemcel) with NO CONTENT CHANGES on 07/01/2025. This is an informational reissue confirming continued coverage for severe sickle cell disease and transfusion-dependent β-thalassemia in patients aged 12+ who meet strict medical necessity criteria. No billing workflow changes are required.

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What to do

Action · 4 steps
01No action required.
02This is a routine annual reissue with no content changes.
03Billing team should file this version (effective 07/01/2025) for reference, but existing prior authorization workflows, medical necessity criteria, and coding for HCPCS J3392 claims remain unchanged.
04Verify your billing system reflects the current criteria: patients must have severe SCD (genotype βS/βS or βS/β0), no HLA-matched donor for allogeneic transplant, eligibility for autologous transplant, prior pharmacologic SCD treatment, and ≥4 severe VOCs in 2 years while on standard treatment.

Codes mentioned

J3392D56.1D57.00D57.01D57.02D57.03D57.04D57.09

Original notice

08.02.14a, Casgevy™ (exagamglogene autotemcel)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.02.14a, Casgevy™ (exagamglogene autotemcel)LowEffective Jul 1, 2025 · Pharmacy08.02.14a, Casgevy™ (exagamglogene autotemcel)LowEffective Jul 1, 2025 · Pharmacy08.02.15, Lovotibeglogene autotemcel (Lyfgenia®)MediumEffective Jan 1, 2025 · Pharmacy08.02.15, Lovotibeglogene autotemcel (Lyfgenia®)LowEffective Jan 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPA policy changesHematologyOncologyPharmacyPediatricsInternal MedicineCode J3392Code D56.1Code D57.00Code D57.01Code D57.02Code D57.03Code D57.04Code D57.09

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