Qalsody® (Tofersen) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Qalsody (tofersen) for ALS only in patients with a confirmed SOD1 mutation and who are not dependent on invasive ventilation, and excludes coverage without documented SOD1 mutation or for ventilator-dependent patients. Coverage requires submission of supporting medical records (including SOD1 test and baseline functional status), prescribing by or in consultation with an ALS‑expert neurologist, dosing per FDA label, initial and renewal authorizations limited to no more than 12 months, and for continuation a provider attestation of slowed disease progression from baseline.

"Patient must not be dependent on invasive ventilation; dependence on invasive ventilation is an exclusion to coverage."

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