細胞和基因治療（CGT）訪問模型-
Medi-Cal 會員常見問題（常見問題）
二零二五年八月一日更新
以下常見問題為 Medi-Cal 成員提供有關 CGT 訪問模式的其他指導和澄清。由於衛生護理服務部（DHCS）收到其他問題，此常見問題將更新。有關 CGT 存取模式的一般資訊，請參閱一般常見問題。
將軍
What might my CGT treatment journey look like under Medi-Cal’s CGT Access Model?
會員接受 CGT 治療的旅程可能包括以下內容：
- 與血液學學家和其他專科醫生的諮詢
- 在治療中心進行全面評估，包括身體需求，行為健康需求和社會支持需求
- 協調治療程序為成員和家庭提供護理和支持服務
- 預備 CGT 的疾病管理
- 生育保育服務
- 基因治療輸液和恢復服務
- 治療後續護理
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 成員必須符合以下所有條件：
- 有證明 SCD 的醫學診斷；
- 在接受 CGT 藥物時積極註冊全方位 Medi-Cal 服務（注意：Medi-Cal 管理護理和服務費（FFS）會員都可能符合 CGT 治療的資格）；
- 將 Medi-Cal 作為主要付款人；
- 從參與提供者那裡接收兩種 CGT 藥物之一；以及
- 符合所有 CGT 存取模型要求，以及 Medi-Cal 提供者手冊和適用的所有計劃信中所述的已發佈 Medi-Cal 政策。
存取 CGT 存取模型服務
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
南加利福尼亞州：
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
涵蓋的 CGT 訪問模式服務，包括生育保護服務
What benefits and services can I receive under Medi-Cal’s CGT Access Model?
- 在 CGT 存取模型下，涵蓋下列費用：
- 用於 SCD 的兩種 CGT 藥物之一
- CASGEVY by Vertex Pharmaceuticals, Inc. – effective October 1, 2025.
- LYFGENIA by bluebird bio, Inc. – effective July 1, 2025.
- 用於 SCD 的兩種 CGT 藥物之一
- 生育保護服務
- 作為 CGT SCD 藥物補償的一部分，製造商涵蓋：
- 最多三輪的生殖材料收集和保存（卵子採集，精子採集和/或睾丸組織提取等）。生育專家醫生和會員確定並同意生育能力保存的確切技術和類型。
- 預付最多十五年樣品儲存
- 如果生育專家判定該會員臨床不適合接受生育保育服務的情況，則需另一次意見諮詢
- 符合條件的住宿、膳食和旅行費用，如有必要，以獲得生育保護服務的情況下，也可以支付
- 作為 CGT SCD 藥物補償的一部分，製造商涵蓋：
本模式不包括哪些類型的生育保育服務？
一些不包括的服務範例如下：
- 胚胎（受精卵）的創造
- 胚胎（受精卵）存儲
- 體外受精（在提供者協助下發生在身體外）
我如何連接到資源？
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:
- 將會員與 QTC 聯繫起來，該醫院是一家受訓練用於進行藍鳥生物基因療法的專門醫院。
- 提供有關各種主題的教育材料，包括基因治療、生育、鐮狀細胞疾病以及特定產品資訊。
- 幫助會員了解他們的保險承保和自付費用，並可以將他們與財務援助計劃聯繫起來。
- 支持成員在治療過程中，並將他們連接到資源。
- 確定參加其他與治療相關的支持計劃的資格並協調，例如旅行和住宿協助
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:
- 花時間認識您，以便他們可以提供有意義的支持
- 回答有關治療過程的問題，並分享有用的指南，以幫助成員及其家人為治療的每個步驟做好準備
- 協調治療過程的物流
- 確定參加其他與治療相關的支持計劃的資格並協調，例如旅行和住宿協助
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:
- 中醫藥管理系統:
- FFS 提供者必須直接向 DHCS 交付和向 DHCS 付款所有其他醫療和非醫療 CGT 相關服務，包括運輸（如上述所述所需的藥物費、生育保護和符合條件的住宿、膳食和旅行費用以外）。
- 醫療管理服務：
- 會員的 Medi-Cal 管理護理計劃必須涵蓋所有其他 CGT 相關的醫療和非醫療服務，包括交通（藥物費、生育保護和合格住宿、膳食以及獲得生育保護服務所需的旅行費用除外）。
反饋
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.