Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
Texas Medicaid Now Participates in the Cell and Gene Therapy Access Model
Date: September 10, 2025
Attention: Hematologists
Effective date: September 1, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like inform providers that on September 1, 2025, Texas Medicaid began to use the Cell and Gene Therapy (CGT) Access Model that was implemented by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.
The CGT Access Model focuses on the following gene therapies for sickle cell disease:
Lyfgenia by bluebird bio
Casgevy by Vertex Pharmaceuticals
These therapies require chemotherapy, which may affect a client’s fertility. Under this model, clients can receive fertility preservation services that are not normally covered by Texas Medicaid. The cost of these fertility preservation services will not be billed to Medicaid or providers – drug manufacturers (bluebird bio and Vertex Pharmaceuticals) will cover the full cost.
Billing process for gene therapies:
Providers must be enrolled with the CMS Designated Registry through the Center for International Blood and Marrow Transplant Research (CIBMTR) before administering the therapy.
Providers must also participate in the CMS study linked to the model (details provided directly from CIBMTR).
Claims must follow the billing requirements in the Texas Medicaid Provider Procedures Manual (TMPPM), including “Separate Reimbursement of Certain Inpatient HCCADs” and “HCCADS Claims Processing Requirements.”
Providers must submit the invoice of the actual acquisition cost of the drug.
Next steps: Providers can find more information about gene therapies, eligibility, claims submission, and related services on the Texas Vendor Drug Program website. Please share this information with your staff.
