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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

This is a reissue of Independence Blue Cross policy 08.02.14a with no substantive changes to coverage criteria for Casgevy (exagamglogene autotemcel), a gene therapy for severe sickle cell disease and transfusion-dependent β-thalassemia in patients 12 years and older. The policy maintains existing medical necessity requirements, including prior treatment attempts, documented severe vaso-occlusive crises, and eligibility criteria. Billing teams should verify this reissue does not affect current claim processing but confirm HCPCS code J3392 remains the appropriate billing code.

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What to do

Action · 4 steps
01No immediate billing workflow changes required.
02By July 1, 2025, confirm that billing system rules for HCPCS code J3392 remain active and that all eight ICD-10 diagnosis codes (D56.1, D57.00-D57.09) are available for claim submission.
03Verify that prior authorization requirements documented in the policy (confirmation of severe SCD/β-thalassemia genotype, documented prior SCD treatment, four or more VOCs in prior 2 years, hematologist/transplant physician prescription, and absence of prior gene therapy) are reflected in your authorization request templates.
04No changes to existing criteria require implementation.

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 changesHematologyOncologyPharmacyPediatricsTransplant SurgeryCode J3392Code D56.1Code D57.00Code D57.01Code D57.02Code D57.03Code D57.04Code D57.09

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