CommercialCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Hematology, Oncology, Pediatrics·Medical Policy
Effective date
Jan 28, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for two gene therapies treating sickle cell disease and beta thalassemia (Lyfgenia and Casgevy). The key change involves editing allogeneic stem cell transplant exclusion criteria to reflect human leukocyte antigen (HLA) matching status for patients under 18 years of age.
Action Required
Before January 28, 2026: Billing team and providers must update documentation requirements for Lyfgenia and Casgevy gene therapy claims. For patients under 18 with sickle cell disease seeking Lyfgenia, document absence of available matched HLA-identical sibling donor. For patients under 18 seeking Casgevy (both sickle cell and beta thalassemia), document absence of known 10/10 HLA matched related donor willing to participate. Update prior authorization request templates to include HLA matching status documentation.