CommercialCoverageMedium impact
08.02.14a, Casgevy™ (exagamglogene autotemcel)
Independence Blue Cross·Pharmacy, Hematology, Oncology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
This is a new pharmacy policy for Casgevy™ (exagamglogene autotemcel), a gene therapy treatment, effective July 1, 2025. The policy establishes coverage criteria, medical necessity requirements, and reimbursement guidelines for this drug. Billing teams must implement prior authorization and documentation requirements for claims submitted on or after the effective date.
Action Required
By June 30, 2025: Billing team and providers must review the complete Casgevy policy at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=06&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-02-14a to extract specific HCPCS codes and prior authorization requirements. Update billing system rules to require prior authorization for Casgevy claims effective 07/01/2025. Add medical necessity documentation requirements to provider encounter templates and pharmacy order processes. Train billing staff on coverage criteria. Obtain prior authorization before dispensing or claims will be denied.