High-Cost Curative Therapy
The FFS (Fee for Service) program shall cover inpatient cell and gene therapy drugs for the treatment of sickle cell disease (SCD) and recurrent vaso-occlusive crises (VOCs) or vaso-occlusive events (VOEs). The following inpatient cell and gene therapy drug products shall be reimbursed under FFS. MCOs (Managed Care Organizations) shall retain responsibility for all costs associated with care, beyond the cost of the high-cost curative therapy drug product.
| Therapy | Generic Name |
| Casgevy | Exagamglogene autotemcel |
| Lyfgenia | Lovotibeglogene autotemcel |
The FFS program shall cover outpatient cell and gene therapy drugs for beneficiaries who require modification or replacement of cells or genes to treat or potentially cure diseases such as genetic disorders, cancers, and other conditions. The following outpatient cell and gene therapy drug products shall be reimbursed under FFS. MCOs shall retain responsibility for all costs associated with care, beyond the cost of the high-cost curative therapy drug product.
| Therapy | Generic Name |
| Roctavian® | Valoctocogene roxaparvovec |
| Hemgenix® | Etranacogene dezaparvovec |
| Beqvez® | Fidanacogene elaparvovec-dzkt |
| Zynteglo® | Betibeglogene autotemcl;beti-cel |
| Elevidys® | Delandistrogene moxeparvovec |
| Zolgensma® | Onasemnogene abeparvovec |
| Luxturna® | Voretigene neparvovec-rzyl |
| Lyfgenia™ | Lovotibeglogene autotemcel |
| Casgevy ® | Exagamglogene autotemcel |
| Lenmeldy ™ | Atidarsagene autotemcel |
| Kebilidi ™ | Eladocagene exuparvovec-tneq |
| Skysona ™ | Elivaldogene autotemcel |
Additional, FDA approved, high-cost curative therapy drugs identified by the District shall also be excluded from MCO coverage and reimbursed on a FFS basis.