MedicaidPrior AuthLow impact
MAB2025110702
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Genetics·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Casgevy (exagamglogene autotemcel), a gene therapy for sickle cell disease and beta-thalassemia. Key changes include removing the restriction on prior gene therapy recipients and adding a requirement that patients be clinically stable for transplantation.
Action Required
By January 5, 2026: If your practice prescribes Casgevy gene therapy, update prior authorization workflows to reflect new medical necessity criteria - patients no longer need to be gene therapy naive, but must be clinically stable for transplantation per prescriber assessment. Review updated Pennsylvania Medicaid handbook pages for complete requirements.