89 Ill. Adm. Code 120.520. CELL AND GENE THERAPY (CGT) ACCESS MODEL PROGRAM

Section 120.520 Cell and Gene Therapy (CGT) Access Model Program

Pursuant to the State of Illinois participation in the Cell and Gene Therapy Access Model (CGT Model), as authorized by Section 115A of the Social Security Act:

a) Cell and gene therapy shall be available to individuals who meet the following criteria:

1) Have a documented medical diagnosis for sickle cell disease;

2) Are enrolled in the Illinois Medical Assistance Program at the time the gene therapy is administered;

3) Have Medicaid as their primary payer;

4) Receive a model drug or gene therapy from a manufacturer that is a participating manufacturer in the CGT Model;

5) Meet the prior authorization criteria outlined in the Department's Casgevy and Lyfgenia policies, published at the Department's website and available at https://ilpriorauth.com/pages/14.

b) For the purposes of this Section, "Model Drug" refers to any drug approved by the FDA that the Centers for Medicare and Medicaid Services has included as a participating therapy in the CGT Model.

(Source: Section repealed at 30 Ill. Reg. 10314, effective May 26, 2006; new Section added at 50 Ill. Reg. 4141, effective February 26, 2026)