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July 4th Holiday Horario de 4 de julio

Texas Children's Health Plan will be closed on Friday, July 4th, in observance of Independence Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Monday, July 7th. Wishing you a safe and happy Independence Day!

Texas Children's Health Plan estará cerrado el viernes 4 de julio por el Día de la Independencia. Durante este tiempo, puede comunicarse con nuestra línea de ayuda disponible las 24 horas, los 7 días de la semana, al 1-800-686-3831. Reanudaremos nuestro horario habitual el lunes 7 de julio. ¡Le deseamos un feliz y seguro el Día de la Independencia!

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ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

Sickle Cell Disease Therapy Coverage Guidance

Date: January 25, 2025

Attention: Hematologists

Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers about the sickle cell disease therapies covered benefit for Texas Medicaid clients. To support this benefit, TCHP and all MCOs must establish a patient care plan for the member. The care plan should consider any transportation or housing needs related to traveling to a qualified treatment centers (QTC). Also, please keep in mind each QTC may have different approaches to managing the treatment process. Also included later in this communication is an important update to the prior authorization requirements for TCHP.

Background information: Casgevy (procedure code J3392) is indicated for the treatment of clients 12 years and older with Sickle cell disease with recurrent vaso-occlusive crises or transfusion-dependent ß-thalassemia. Lyfgenia (procedure code J3394) is indicated for the treatment of clients 12 years of age or older with sickle cell disease and a history of vaso-occlusive events. These gene therapies are administered in QTC for clients who meet the prior authorization criteria.

How this impacts providers: 

Prior authorization update information:

Casgevy, J3392 and Lyfgenia, J3394 prior authorization requirement, age and diagnosis restrictions:

  • Casgevy (procedure code J3392) is indicated for the treatment of clients 12 years and older with Sickle cell disease with recurrent vaso-occlusive crises or transfusion-dependent ß-thalassemia
  • Lyfgenia (procedure code J3394) is indicated for the treatment of clients 12 years of age or older with sickle cell disease and a history of vaso-occlusive events 

Treatment consists of six phases:

1. Patient Identification and Evaluation

2. Pre-Mobilization

3. Mobilization and Collection

4. Product Manufacturing and Quality

5. Conditioning, Administration, and Engraftment

6. Long-term follow-up

Resources:

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.