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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Neurology, Family Medicine, Internal MedicineMedium impact

Qalsody (tofersen)

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

BCBS MS has classified Qalsody (tofersen) as investigational for ALS treatment, meaning claims will be denied. The drug requires prior authorization review, and services related to administration without PA approval will be considered not medically necessary.

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What to do

immediately · 4 steps
01Stop billing J1304 (tofersen injection) without prior authorization.
02Billing team must ensure all Qalsody administration requires BCBSMS PA approval before service delivery.
03Update billing system to flag J1304 as investigational and requiring PA.
04Claims without PA will be denied as not medically necessary.

Codes mentioned

J1304

Original notice

Qalsody (tofersen)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Qalsody (tofersen)LowNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesNeurologyFamily MedicineInternal MedicineCode J1304

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