MedicaidReimbursementMedium impact
Notice of intent – OHA will amend the Medicaid State Plan to reimburse two drug therapies for sickle cell disease at Actual Acquisition Cost.
Oregon Health Plan·OR · Hematology, Oncology·Public notice
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Oregon Medicaid will change reimbursement for two sickle cell disease gene therapies (Casgevy™ and Lyfgenia™) from bundled DRG payments to separate Actual Acquisition Cost reimbursement for hospitals. This affects both inpatient and outpatient billing for these specific gene therapy drugs.
Action Required
Before January 1, 2026: Billing teams at hospitals treating sickle cell patients must update billing systems to exclude Casgevy™ and Lyfgenia™ from DRG bundled payments and bill these drugs separately at Actual Acquisition Cost. Update charge capture processes to identify these gene therapies for separate billing. This only affects Oregon Medicaid claims.