Casgevy and Lyfgenia: Coverage Information for SelectHealth Members

Patients enrolled in SelectHealth may be eligible for coverage for Casgevy and Lyfgenia through NYRx, the Medicaid Pharmacy Program, when certain criteria are met. The plan will assist providers and members in obtaining approval for these medications through a few simple steps.

Once the health plan receives a request from the provider for Casgevy or Lyfgenia, our team will complete the New York State worksheet. The plan will review the necessary criteria for coverage. If the member is eligible for the medication, the plan will facilitate communication of eligibility with the state. NYRx will then work with a specialty pharmacy to dispense the medication. 

For more information regarding the Casgevy and Lyfgenia worksheet and the New York Medicaid Managed Care Plan Approval for Related Services Form Cell and Gene Therapy, please visit the following link here.