Check member coverage, requirements for gene therapy services
March 12, 2020
This article is for hospitals, outpatient clinics, and other providers using gene therapies to treat our members
Before performing gene therapy services, such as CAR-T therapy, Kymriah, Luxturna, Yescarta, and Zolgensma, it’s important to know what’s covered.
What is gene therapy?
Gene therapy involves altering the genes in a person’s body to treat or stop a disease.
The therapy may introduce new genetic material into a patient to replace or correct faulty or missing genetic material, or to make a new gene.
Does Blue Cross cover gene therapies?
Please be sure to check member benefits and eligibility before performing gene therapy services. Please note:
- Some self-insured employers do not offer their employees benefits for these therapies, so it’s important to check each member’s coverage.
- We're working to add a message to the 270/271 eligibility and benefit transaction. In the meantime, if you have questions, you can contact Provider Service.
- Because these are highly specialized therapies, most require prior authorization.
Review our medical policies
Our medical policies describe our coverage for gene therapy services, which may be through the member’s medical or pharmacy benefits. The medical policies contain prior authorization request forms that you can fill out and fax to us at the number listed on the form.