Sickle cell disease is a group of inherited red blood cell disorders. When someone has sickle cell disease, their red blood cells become hard and sticky. When they travel through small blood vessels, sickle cells get stuck and clog the blood flow. This can cause pain and other health problems such as infection and stroke.
PCHP’s STAR (Medicaid) members with sickle cell disease now have access to a treatment called gene therapy, which can help improve their quality of life. The process usually involves:
- Talking with a hematologist (a doctor who specializes in blood diseases).
- Working with a service coordinator to identify physical, behavioral, and social support needs.
- Preparing for gene therapy.
- Collecting stem cells at a treatment center.
- Gene therapy infusion and recovery at a treatment center.
- Follow-up care.
To learn more about a typical journey through the gene therapy process, click here.
Clinical Prior Authorization
Prior authorization is an approval that PCHP requires for certain services and medications. Some services need approval before they are given and your provider should get this approval for you or your child.
To see what medications need prior approval, follow these steps:
- Visit the Texas Medicaid Provider Procedures Manual.
- Scroll down to the Outpatient Drug Services Handbook.
- When the PDF opens, click on the magnifying glass in the top right corner or click Ctrl+F to search in the document.
- Search for your medication by entering the drug name. Example: Casgevy or Lyfgenia.
- Review the prior authorization criteria for the drug.
Additional Resources
If you have sickle cell disease, you may qualify for gene therapy treatment. Talk to your doctor to see if you qualify for one of the following treatment options:
These gene therapy options include services to protect your fertility.
Call us at 1-888-672-2277 (STAR) to learn more about PCHP’s service coordination.
093_03_20250916_002MC