CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - Qalsody (tofersen)
Blue Cross & Blue Shield of Mississippi·MS · Neurology·Medical Policy
We identified it
Jun 20, 2026
Summary
The Mississippi State and School Employees' Health Insurance Plan has classified Qalsody (tofersen) as investigational for ALS treatment, meaning it will not be covered due to insufficient evidence of clinical benefit. Claims for this medication and its administration will be denied.
Action Required
Immediately: Billing team must flag HCPCS code J1304 (tofersen injection) as non-covered investigational treatment in billing system. Inform providers that Qalsody claims for Mississippi State and School Employees plan members will be denied. Update encounter forms to note investigational status.