细胞和基因治疗（CGT）获取模型-
Medi-Cal 会员常见问题解答 (FAQ)
更新于2025年8月1日
以下常见问题解答为 Medi-Cal 会员提供有关 CGT 访问模型的更多指导和说明。随着卫生保健服务部 (DHCS) 收到更多问题，此常见问题解答将会更新。有关 CGT 访问模型的一般信息，请参阅常见问题解答。
一般的
What might my CGT treatment journey look like under Medi-Cal’s CGT Access Model?
会员接受 CGT 治疗的历程可能包括以下内容：
- 与血液学家和其他专家的咨询
- 治疗中心的综合评估包括身体需求、行为健康需求和社会支持需求
- 为正在接受治疗的会员和家人协调护理和支持服务
- 为准备接受 CGT 而进行的疾病管理
- 生育力保存服务
- 基因治疗输注和恢复服务
- 治疗后后续护理
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.
合格
Am I eligible to participate in Medi-Cal’s CGT Access Model and receive CGT SCD medications?
Medi-Cal 会员必须满足以下所有条件：
- 有记录的 SCD 医学诊断；
- 在接受 CGT 药物治疗时，积极加入全范围的 Medi-Cal（注意：Medi-Cal 管理式医疗和按服务收费 (FFS) 成员均有资格接受 CGT 治疗）；
- 以 Medi-Cal 作为主要付款人；
- 从参与计划的医疗服务提供者处获得两种 CGT 药物中的一种；并且
- 满足所有 CGT 访问模型要求以及 Medi-Cal 提供商手册和适用的所有计划信函中概述的已发布的 Medi-Cal 政策。
访问CGT访问模型服务
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
南加州：
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
涵盖的CGT接入模型服务，包括生育力保存服务
What benefits and services can I receive under Medi-Cal’s CGT Access Model?
- 根据 CGT 访问模型，以下费用可得到涵盖：
- 两种治疗 SCD 的 CGT 药物之一
- CASGEVY by Vertex Pharmaceuticals, Inc. – effective October 1, 2025.
- LYFGENIA by bluebird bio, Inc. – effective July 1, 2025.
- 两种治疗 SCD 的 CGT 药物之一
- 生育力保存服务
- 作为 CGT SCD 药物报销的一部分，制造商涵盖：
- 最多三轮生殖材料的收集和保存（卵子采集、精子采集和/或睾丸组织提取等）。生育力保存的具体技术和类型将由生育专家医生和会员确定并商定。
- 预付最多十五年的样品存储费用
- 如果生育专家确定会员在临床上不适合接受生育保护服务，则进行一次第二意见咨询
- 如果需要接受生育保护服务，符合条件的住宿、餐饮和旅行费用也可能得到报销
- 作为 CGT SCD 药物报销的一部分，制造商涵盖：
该模型不包括哪些类型的生育力保存服务？
一些未包含的服务示例如下：
- 胚胎（受精卵）的形成
- 胚胎（受精卵）储存
- 体外受精（在提供者的协助下在体外进行）
我如何才能连接到资源？
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:
- 将会员与QTC联系起来，QTC 是一家专门接受过管理蓝鸟生物基因疗法培训的医院。
- 提供各种主题的教育材料，包括基因治疗、生育能力、镰状细胞病和产品特定信息。
- 帮助会员了解他们的保险范围和自付费用，并可能为他们提供财务援助计划。
- 在治疗过程中为会员提供支持并为他们提供资源。
- 确定资格并协调额外的治疗相关支持计划，例如旅行和住宿援助
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:
- 花时间了解你，这样他们才能提供有意义的支持
- 回答有关治疗过程的问题并分享有用的指南，帮助会员及其家人为治疗的每个步骤做好准备
- 协调您的治疗过程的后勤工作
- 确定资格并协调额外的治疗相关支持计划，例如旅行和住宿援助
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：
- FFS 提供商必须直接向 DHCS 提供并收取所有其他医疗和非医疗 CGT 相关服务的费用，包括交通费用（除上述接受生育力保存服务所需的药品费用、生育力保存费用以及合格的住宿、餐饮和旅行费用外）。
- Medi-Cal 管理式医疗：
- 会员的 Medi-Cal 管理式医疗计划必须涵盖所有其他医疗和非医疗 CGT 相关服务，包括交通（除上述接受生育力保存服务所需的药品费用、生育力保存费用以及合格的住宿、餐饮和旅行费用外）。
反馈
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.