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CommercialCoverageMedium impact

Qalsody (tofersen)

Blue Cross & Blue Shield of Mississippi·MS · Neurology, Family Medicine, Internal Medicine·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

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.

Action Required

Action needed
Immediately: Stop billing J1304 (tofersen injection) without prior authorization. Billing team must ensure all Qalsody administration requires BCBSMS PA approval before service delivery. Update billing system to flag J1304 as investigational and requiring PA. Claims without PA will be denied as not medically necessary.

Affected Billing Codes

J1304

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