Cell and Gene Therapy (CGT) Access Model-
Mga Madalas Itanong sa Miyembro ng Medi-Cal (Mga FAQ)
Na-update noong Agosto 1, 2025
Ang mga sumusunod na FAQ ay nagbibigay ng karagdagang gabay at paglilinaw para sa mga miyembro ng Medi-Cal tungkol sa CGT Access Model. Habang ang Department of Health Care Services (DHCS) ay tumatanggap ng mga karagdagang tanong, ang FAQ na ito ay ia-update. Para sa pangkalahatang impormasyon tungkol sa CGT Access Model, mangyaring sumangguni sa Mga Pangkalahatang FAQ.
Heneral
What might my CGT treatment journey look like under Medi-Cal’s CGT Access Model?
Ang paglalakbay ng isang miyembro sa pagtanggap ng paggamot sa CGT ay maaaring kasama ang sumusunod:
- Mga konsultasyon sa mga hematologist at iba pang mga espesyalista
- Komprehensibong pagsusuri sa sentro ng paggamot kabilang ang mga pisikal na pangangailangan, mga pangangailangan sa kalusugan ng pag-uugali, at mga pangangailangan sa suporta sa lipunan
- Koordinasyon ng pangangalaga at suportang mga serbisyo para sa mga miyembro at pamilya na nagna-navigate sa proseso ng paggamot
- Pamamahala ng sakit bilang paghahanda para sa CGT
- Mga serbisyo sa pangangalaga ng fertility
- Gene therapy infusion at mga serbisyo sa pagbawi
- Pangangalaga pagkatapos ng paggamot
How do I know which CGT SCD medication I will receive through Medi-Cal’s CGT Access Model?
Medi-Cal’s CGT Access Model will cover the two federal Food and Drug Administration (FDA)-approved CGT medications for treatment of sickle cell disease (SCD). This includes, CASGEVY™, which is made by Vertex Pharmaceuticals, Inc., and LYFGENIA™, which is made by bluebird bio, Inc. Your doctor will determine which CGT SCD medication is most appropriate for your individual circumstances and submit the necessary request on your behalf so you can participate in the CGT Access Model and receive the CGT SCD medication.
Can CGT medications for SCD affect my fertility (ability to have children)?
Yes, chemotherapy used in stem cell transplants during CGT treatments may impact your fertility (ability to have children). However, because of this fact, fertility preservation services are covered and available to members under Medi-Cal’s CGT Access Model. You are encouraged to discuss fertility preservation options with your doctor once approved for but before starting CGT treatment. Please see the Covered CGT Access Model Services, Including Fertility Preservation Services section of this FAQ for more information.
Pagiging karapat-dapat
Am I eligible to participate in Medi-Cal’s CGT Access Model and receive CGT SCD medications?
Dapat matugunan ng mga miyembro ng Medi-Cal ang lahat ng sumusunod na pamantayan:
- Magkaroon ng dokumentadong medikal na diagnosis ng SCD;
- Maging aktibong nakatala sa buong saklaw na Medi-Cal sa oras na matanggap ang CGT na gamot (tandaan: parehong miyembro ng Medi-Cal managed care at fee-for-service (FFS) ay maaaring maging karapat-dapat para sa mga CGT therapies);
- Magkaroon ng Medi-Cal bilang kanilang pangunahing nagbabayad;
- Tumanggap ng isa sa dalawang CGT na gamot mula sa isang kalahok na provider; at
- Matugunan ang lahat ng kinakailangan ng CGT Access Model pati na rin ang na-publish na patakaran ng Medi-Cal gaya ng nakabalangkas sa Medi-Cal Provider Manual at naaangkop na All Plan Letter.
Pag-access sa CGT Access Model Services
How do I access CGT SCD medications under Medi-Cal’s GCT Access Model?
If you have Medi-Cal FFS, you should consult with your doctor to determine eligibility and learn more as well as for information on accessing CGT SCD medications. Medi-Cal FFS providers can assist members with accessing one of the two CGT SCD medications.
Medi-Cal managed care members should contact their doctor or Medi-Cal managed care plan (MCP) to determine eligibility and learn more about CGT services. Medi-Cal MCPs are responsible for care coordination and assisting members with accessing one of the two CGT sickle cell disease medications. For more information on Medi-Cal MCP care coordination and other requirements, please review the applicable All Plan Letter on DHCS’ website. Each Medi-Cal MCP includes a point of contact, which can be found in the Medi-Cal Managed Care Health Plan Directory.
If approved for participation in Medi-Cal’s CGT Access Model to receive LYFGENIA, where will that happen?
LYFGENIA treatments are only available and administered at Qualified Treatment Centers (QTCs) centers that have the appropriate experience and training to do so. There are currently eight (8) QTCs that offer LYFGENIA in California, which are bulleted below. You may search for QTCs closest to you on this website: LYFGENIA™ (lovotibeglogene autotemcel) Qualified Treatment Center Locator. Your LYFGENIA patient navigator (available with mybluebirdbio enrollment) may also assist you with identifying a QTC closet to you.
Northern California:
UCSF Benioff Children’s Hospital
Oakland 747 52nd Street, Oakland, CA 94608
510-428-3000
UCSF Benioff Children’s Hospital San Francisco
1975 4th Street, San Francisco, CA 94158
415-476-2188
Lucile Packard Children’s Hospital at Stanford
725 Welch Road, Palo Alto, CA 94304
650-725-3158
Southern California:
UCLA
757 Westwood Plaza, Los Angeles, CA 90095
310-260-6909
310-825-6708
Children’s Hospital Los Angeles
4650 Sunset Blvd., Los Angeles, CA 90027
323-361-4624
City of Hope National Medical Center
1500 E Duarte Road, Duarte CA, 91010
1-800-826-4673
Loma Linda University Children’s Hospital
11234 Anderson Street, Loma Linda, CA 92354
909-558-4000
Loma Linda University Medical Center
11234 Anderson Street, Loma Linda, CA 92354
909-558-4000
If approved for participation in Medi-Cal’s CGT Access Model to receive CASGEVY, where will that happen?
CASGEVY treatments are only available and administered at Authorized Treatment Centers (ATCs) that have the appropriate experience and training to do so. There are 6 ATCs that offer CASGEVY in California. You may search for ATCs closest to you on this website: Authorized Treatment Center Locator | CASGEVY® (exagamglogene autotemcel).
Northern California:
UCSF Benioff Children’s Hospital San Francisco
1975 4th Street
San Francisco, 94158
Benioff Children’s Hospital Oakland
747 52nd St.
Oakland, 94609
(510) 428-3885 ext. 5183
amy.solari@ucsf.edu
Southern California:
City of Hope National Medical Center
1500 East Duarte Road
Duarte, 91010
(800) 826-4673
genetherapy@coh.org
Children’s Hospital of Orange County
1201 W. La Veta Avenue
Orange, 92868
UCLA Health
757 Westwood Plaza
Los Angeles, 90095
310-260-6909
Children’s Hospital Los Angeles
4650 Sunset Boulevard
Los Angeles, 90027
(323) 361-4624
Mga Saklaw na Serbisyo ng Modelo ng Pag-access ng CGT, Kasama ang Mga Serbisyo sa Pagpapanatili ng Fertility
What benefits and services can I receive under Medi-Cal’s CGT Access Model?
- Sa ilalim ng CGT Access Model, sinasaklaw ang mga sumusunod na gastos:
- Isa sa dalawang CGT na gamot para sa SCD
- CASGEVY by Vertex Pharmaceuticals, Inc. – effective October 1, 2025.
- LYFGENIA by bluebird bio, Inc. – effective July 1, 2025.
- Isa sa dalawang CGT na gamot para sa SCD
- Mga Serbisyo sa Pagpapanatili ng Fertility
- Bilang bahagi ng reimbursement para sa mga gamot sa CGT SCD, sinasaklaw ng mga manufacturer ang:
- Hanggang sa tatlong round ng pagkolekta at pag-iingat ng reproductive material (pag-aani ng itlog, pagkolekta ng sperm, at/o pagkuha ng testicular tissue, atbp.). Ang eksaktong pamamaraan at uri ng pangangalaga ng fertility ay tutukuyin at sasang-ayunan ng Fertility Specialist na manggagamot at ng miyembro.
- Paunang pagbabayad ng hanggang labinlimang taon ng pag-iimbak ng mga sample
- Isang pangalawang opinyon na konsultasyon sa mga kaso kung saan natukoy ng isang Fertility Specialist na ang miyembro ay hindi klinikal na naaangkop para sa mga serbisyo sa pangangalaga ng fertility
- Ang kwalipikadong panuluyan, pagkain, at mga gastos sa paglalakbay ay maaari ding sakupin, kung kinakailangan upang makatanggap ng mga serbisyo sa pangangalaga ng fertility
- Bilang bahagi ng reimbursement para sa mga gamot sa CGT SCD, sinasaklaw ng mga manufacturer ang:
Anong mga uri ng mga serbisyo sa pangangalaga sa pagkamayabong ang HINDI kasama sa ilalim ng Modelo?
Ang ilang mga halimbawa ng mga serbisyong HINDI kasama ay ang mga sumusunod:
- Paglikha ng embryo (fertilized egg).
- Imbakan ng embryo (fertilized egg).
- In-vitro fertilization (nagaganap sa labas ng katawan sa tulong ng provider)
Paano ako makakakonekta sa mga mapagkukunan?
Medi-Cal members who are considering or in the process of receiving bluebird bio’s LYFGENIA gene therapy treatment will receive Patient Navigators through my bluebird support, who can:
- Ikonekta ang mga miyembro sa isang QTC, na isang espesyal na ospital na sinanay upang mangasiwa ng mga bluebird bio gene therapies.
- Magbigay ng mga materyal na pang-edukasyon sa iba't ibang paksa, kabilang ang gene therapy, fertility, sickle cell disease, at impormasyong partikular sa produkto.
- Tulungan ang mga miyembro na maunawaan ang kanilang insurance coverage at out-of-pocket na mga gastos at maaaring maiugnay sila sa mga programa ng tulong pinansyal.
- Suportahan ang mga miyembro sa pamamagitan ng paglalakbay sa paggamot at ikonekta sila sa mga mapagkukunan.
- Tukuyin ang pagiging karapat-dapat para sa at pag-ugnayin ang mga karagdagang programa ng suportang nauugnay sa paggamot, tulad ng tulong sa paglalakbay at panunuluyan
Please note that my bluebird support is available to members at no cost, and there is no obligation to move forward with CGT SCD treatment. To get connected with a Patient Navigator, please complete my bluebird support’s Program Enrollment Form.
Medi-Cal members who are starting treatment with Vertex Pharmaceuticals’ CASGEVY may enroll in Vertex Connects to receive a Case Manager, who can:
- Gumugol ng oras na kilalanin ka para makapagbigay sila ng makabuluhang suporta
- Sagutin ang mga tanong tungkol sa proseso ng paggamot at magbahagi ng mga kapaki-pakinabang na gabay upang matulungan ang mga miyembro at kanilang pamilya na maghanda para sa bawat hakbang ng paggamot
- I-coordinate ang logistik ng iyong paglalakbay sa paggamot
- Tukuyin ang pagiging karapat-dapat para sa at pag-ugnayin ang mga karagdagang programa ng suportang nauugnay sa paggamot, tulad ng tulong sa paglalakbay at panunuluyan
Enrollment in Vertex Connects Patient Support is not required to receive CASGEVY. However, a completed Vertex Connects enrollment form is needed to receive case management services and determine eligibility for certain program offerings. Members will receive a Vertex Connects enrollment form once they are prescribed CASGEVY treatment by their healthcare team.
What expenses are covered for the Medi-Cal member by the CGT therapy manufacturer if travel is necessary to receive fertility preservation services?
CGT therapy manufacturers are responsible for providing reimbursement to eligible members for mileage, tolls, and parking upon presentation of valid receipt, consistent with all applicable manufacturer policy. Manufacturers may also arrange transportation (via air, train, bus, car rental) for the member and caregivers to and from the fertility preservation provider. If an overnight stay is required, CGT therapy manufacturers may provide a modest single hotel room for up to two nights per visit and a reasonable per diem for food expenses for both the member and their parent/caregiver.
For more specific information about eligibility for travel coverage and reimbursement as well as for assistance with travel arrangements, members receiving bluebird bio’s LYFGENIA, should work with their assigned Patient Navigator and utilize my bluebird support. Similarly, members receiving Vertex’s CASGEVY should directly work with their Vertex Connects patient support team.
What benefits and services are NOT part of Medi-Cal’s CGT Access Model and how will I receive them?
Aside from the two CGT medications and, if needed, fertility preservation services, all other medical and non-medical services are not covered under the CGT Access Model and will be provided and covered depending on your Medi-Cal eligibility, as follows:
- Medi-Cal FFS:
- Ang mga tagapagkaloob ng FFS ay dapat maghatid at direktang singilin ang DHCS para sa lahat ng iba pang serbisyong nauugnay sa medikal at hindi medikal na CGT, kabilang ang transportasyon (sa labas ng halaga ng gamot, pangangalaga sa fertility, at kwalipikadong tuluyan, pagkain, at mga gastos sa paglalakbay na kinakailangan upang makatanggap ng mga serbisyo sa pangangalaga ng fertility tulad ng nabanggit sa itaas).
- Medi-Cal Managed Care:
- Ang plano ng pinamamahalaang pangangalaga ng Medi-Cal ng miyembro ay dapat sumaklaw sa lahat ng iba pang serbisyong medikal at hindi medikal na nauugnay sa CGT, kabilang ang transportasyon (sa labas ng halaga ng gamot, pangangalaga sa fertility, at kwalipikadong tuluyan, pagkain, at mga gastos sa paglalakbay na kinakailangan upang makatanggap ng mga serbisyo sa pangangalaga ng fertility, tulad ng nabanggit sa itaas).
Feedback
Where can I learn more about Medi-Cal’s CGT Access Model and/or provide feedback?
Information about Medi-Cal’s CGT Access Model is available on DHCS’ website, which is available at the following link: Feedback, questions, and comments may also be submitted to DHCS via email at dhcscgt@dhcs.ca.gov.