MedicaidPrior AuthMedium impact
Qalsody™ (tofersen) (New)
Humana·IN · Neurology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Qalsody™ (tofersen), a specialized intrathecal treatment for ALS patients with SOD1 gene mutations. The policy requires extensive documentation including genetic testing, neurofilament lab results, and specialist evaluation before approval.
Action Required
By June 1, 2026: Billing team must implement prior authorization requirements for Qalsody™ (tofersen) for Indiana Medicaid patients. Providers must obtain genetic testing confirmation, baseline neurofilament light chain lab results, and specialist documentation before prescribing. Update system to flag this medication for prior auth and create documentation checklist for neurology providers.