Zynteglo (betibeglogene autotemcel): Coverage Information for SelectHealth Members

Patients enrolled in SelectHealth may be eligible for coverage for Zynteglo through NYRx, the Medicaid Pharmacy Program when certain criteria are met. The SelectHealth health plan can assist providers and members in obtaining approval for the medication through a few simple steps.

Once the health plan receives a request for Zynteglo, our team will send the patient’s physician a New York State worksheet for completion. Once the plan receives the completed worksheet, the plan will review New York State Medicaid criteria for coverage. If the member is eligible for the medication, the plan will facilitate communication of the eligibility with the state. NYRx will then work with a specialty pharmacy to dispense the medication.

For more information regarding the Zynteglo worksheet and clinical criteria information, please visit the following link here.