Topic

Qalsody (tofersen)

A collection of 29 issues

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in California Qalsody (tofersen) requires prior authorization through UnitedHealthcare's OptumRx with strict documentation requirements. You'll need genetic confirmation of SOD1 mutation, neurologist involvement, baseline ALSFRS-R scores, and evidence of riluzole/edaravone trial or contraindication. Submit via the UnitedHealthcare provider
6 min read

How to Get Qalsody (tofersen) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Qalsody (tofersen) Approved by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Qalsody (tofersen) with documented SOD1 mutation, neurologist prescription, and baseline assessments. First step: Submit Aetna's Qalsody precertification form with genetic test results, ALSFRS-R scores, and clinical notes. Standard approval
4 min read

How to Get Qalsody (tofersen) Covered by Blue Cross Blue Shield of Georgia: Complete Prior Authorization Guide with Appeals and State Protections

Answer Box: Getting Qalsody (tofersen) Covered by Blue Cross Blue Shield of Georgia Blue Cross Blue Shield of Georgia (Anthem) covers Qalsody (tofersen) for adults with confirmed SOD1 mutation ALS through prior authorization. The fastest path to approval requires: (1) genetic test confirming SOD1 mutation, (2) neurologist documentation of ALS
6 min read

Renewing Qalsody (Tofersen) Coverage with Aetna CVS Health in Georgia: Timeline, Documentation & Bridge Options

Answer Box: Renewing Qalsody (Tofersen) with Aetna CVS Health in Georgia Aetna CVS Health requires annual renewal for Qalsody (tofersen) with updated clinical documentation showing continued medical necessity. Start renewal 2-4 weeks before expiration to avoid therapy gaps. Required: neurologist attestation of slowed ALS progression, current ALSFRS-R scores, confirmed SOD1
5 min read

Renewing Qalsody (Tofersen) Approval with Cigna in Virginia: 2025 Guide to Documentation, Timelines, and Appeals

Answer Box: Renewing Your Qalsody (Tofersen) Coverage with Cigna Quick Summary: Cigna typically requires Qalsody (tofersen) renewal every 6 months for SOD1-ALS patients. Submit renewal documentation 2-4 weeks before your current authorization expires using CoverMyMeds or the EviCore portal. Required documents include updated ALSFRS-R scores, neurofilament light chain (NfL) levels,
5 min read

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Provider Partnership Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in Florida Qalsody (tofersen) requires prior authorization through OptumRx for all UnitedHealthcare plans in Florida. Essential requirements include documented SOD1 gene mutation, ALS diagnosis by a neurologist, baseline ALSFRS-R score, and confirmation the patient isn't on invasive ventilation. Submit PA requests
7 min read

Qalsody (Tofersen) Approval with UnitedHealthcare in Michigan: Answers to the Most Common Questions

Answer Box: Getting Qalsody (Tofersen) Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization through OptumRx. Key requirements: SOD1 genetic testing, neurologist prescription, baseline ALSFRS-R score, and no invasive ventilation. If denied, Michigan residents have 127 days to
6 min read