New Jersey Medicaid: Billing guidance for sickle cell disease treatments

In July 2025, CMS awarded the state of New Jersey the opportunity to participate in the Cell and Gene Therapy (CGT) Access Model through its Cooperative Agreement funding program. Participation in the CGT program provides Medicaid enrollees diagnosed with sickle cell disease with access to cell and gene therapies at reduced costs through the state’s Medicaid program. 

For information on UnitedHealthcare provider requirements, applicable drugs for treatment, prior authorization requirements and claim submissions, please review the Billing guidance for Sickle Cell Disease (SCD) gene therapies.

Other resources

New Jersey Department of Human Services, Division of Medical Assistance & Health Services:

• Medicaid Alert - MA-2025-04: The Cell and Gene Therapy (CGT) Access Model and Related Billing Guidance for Sickle Cell Disease (SCD) Gene Therapy

• Drug Utilization Review Board: DURB Approved Protocols – Clinical criteria for drugs included in the CGT model