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Cell thiab Gene Therapy Access Model
Keeb kwm
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau thov rau kev koom tes hauv tsoomfwv Lub Chaw rau Medicare thiab Medicaid Services' (CMS') Cell thiab Gene Therapy (CGT) Access Model Lub Peb Hlis 11, 2025. DHCS tau txais kev pom zoo los ntawm CMS thiab raug lees txais rau hauv CGT Access Model rau Medi-Cal txij li lub Peb Hlis 25, 2025.
Cov qauv no yog tsim los txhim kho thiab ua kom yooj yim Nkag mus rau cov tshuaj CGT hloov pauv lub neej rau Medi-Cal cov tswv cuab hauv ob qho tib si tus nqi-rau-kev pabcuam (FFS) thiab tswj kev saib xyuas cov kab mob tsawg thiab hnyav. Hauv kev ua raws li CMS cov cai, lub hom phiaj tseem ceeb ntawm CGT Access Model yuav yog ntawm kev muab kev pab them nqi kho mob ntawm tes thiab noob caj noob ces tshwj xeeb tau pom zoo rau kev kho mob ntawm tes mob rau Medi-Cal cov tswv cuab. Qhov no suav nrog cov kev kho mob hauv qab no:
- CASGEVY los ntawm Vertex Pharmaceuticals, Inc. - pib lub Kaum Hli 1, 2025.
- LYFGENIA los ntawm bluebird bio, Inc. - siv tau Lub Xya Hli 1, 2025.
Los ntawm kev txhawb kev nkag tau zoo dua rau cov tshuaj CGT no, Medi-Cal cov tswv cuab yuav tsum tau txais kev noj qab haus huv thiab kev ua neej zoo. DHCS cia siab tias cov tshuaj CGT ntxiv rau lwm yam kab mob tsawg thiab hnyav yuav raug ntxiv rau lub sijhawm thiab cov cai yuav raug hloov kho raws li.
Medi-Cal Tus Tswv Cuab Txoj Kev Kho Mob CGT
Ib tug tswv cuab txoj kev taug kev tau txais kev kho mob yuav suav nrog cov hauv qab no:
- Kev sab laj nrog hematologists thiab lwm tus kws kho mob tshwj xeeb
- Kev ntsuam xyuas tag nrho ntawm qhov chaw kho mob suav nrog kev xav tau ntawm lub cev, kev xav tau ntawm tus cwj pwm kev noj qab haus huv, thiab kev xav tau kev txhawb nqa kev sib raug zoo
- Kev sib koom tes ntawm kev saib xyuas thiab kev pab txhawb nqa rau cov tswv cuab thiab tsev neeg taug txoj kev kho mob
- Kev tswj kab mob hauv kev npaj rau CGT
- Fertility preservation Services
- Gene therapy infusion thiab kev pabcuam rov qab
- Kev kho mob tom qab kev kho mob
Cov txiaj ntsig thiab kev pabcuam tau them raws li CGT Access Model
Raws li CGT Access Model, cov nqi hauv qab no raug them:
- Ib qho ntawm ob cov tshuaj CGT rau SCD
- CASGEVY los ntawm Vertex Pharmaceuticals, Inc.
- LYFGENIA los ntawm Bluebird bio, Inc.
- Fertility Preservation Services
- Cov tuam txhab tshuaj tau npog txog li peb zaug ntawm kev sau thiab khaws cia, txog li kaum tsib xyoos rau cov tswv cuab tsim nyog.
- Kev tsim nyog qhov chaw nyob, zaub mov, thiab cov nqi mus ncig kuj yuav raug them, yog tias tsim nyog tau txais cov kev pabcuam khaws cia muaj menyuam.
CGT Access Model Kev Tsim Nyog
Yuav kom tsim nyog rau Medi-Cal tus CGT Access Model, Medi-Cal cov tswv cuab yuav tsum muaj cov ntaub ntawv kho mob ntawm SCD, koom nrog Medi-Cal thaum lub sij hawm tau txais kev kho mob, muaj Medi-Cal ua lawv tus thawj them nyiaj, tau txais ib qho ntawm ob CGTs los ntawm ib tus kws kho mob koom nrog, thiab ua tau raws li tag nrho cov kev cai ntawm Medi-Cal. Yog xav paub ntxiv, thov xa mus rau Medi-Cal txoj cai thiab them nyiaj rov qab.
Nkag mus rau CGT Kev Kho Mob
Medi-Cal FFS : - Medi-Cal FFS cov tswv cuab yuav tsum sab laj nrog lawv tus kws kho mob kom paub txog kev tsim nyog CGT thiab tau txais kev kho mob CGT raws li Medi-Cal's CGT Access Model.
Medi-Cal Managed Care : - Medi-Cal cov tswv cuab tswj hwm yuav tsum sab laj nrog lawv tus kws kho mob lossis hu rau lawv qhov kev npaj kho mob Medi-Cal tswj hwm (MCP) kom paub ntau ntxiv txog cov tshuaj CGT muaj nyob hauv Medi-Cal's CGT Access Model.
- Medi-Cal MCPs yog lub luag haujlwm rau kev saib xyuas kev sib koom tes thiab pab lawv cov tswvcuab nkag mus rau ib qho ntawm ob qho tshuaj tiv thaiv kab mob CGT.
- Yog xav paub ntxiv txog Medi-Cal MCP kev saib xyuas kev sib koom tes thiab lwm yam yuav tsum tau ua, thov tshuaj xyuas Daim Ntawv Qhia Tag Nrho uas siv tau ntawm DHCS' Lub vev xaib .
- Txhua Medi-Cal MCP suav nrog cov ntsiab lus ntawm kev sib cuag rau cov lus nug dav dav, uas tuaj yeem nrhiav tau hauv Medi-Cal Managed Care Health Plan Directory.
- Thov nco ntsoov tias ob yam tshuaj CGT uas tau them los ntawm Medi-Cal's CGT Access Model yog "tshem tawm" ntawm Medi-Cal MCP cov ntawv cog lus, uas txhais tau hais tias lawv tsis yog muab los ntawm Medi-Cal MCPs tab sis yog muab los ntawm Medi-Cal FFS cov kws kho mob uas tej zaum yuav lossis tsis yog ib feem ntawm Medi-Cal MCP lub network thiab raug them ncaj qha rau DHCS.
Hnub hloov tshiab kawg: 10/3/2025 11:27 AM
