29 commercial payer policies list J1304. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
Free account. Policy pages stay open to everyone.
29 policies from 21 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (tofersen intrathecal injection) | Oct 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Qalsody (tofersen intrathecal injection) Medicare AdvantageEffective 06/01/2025 - 05/31/2026 | Jun 1, 2025 | Prior auth requiredInferred from policy title |
| Qalsody (tofersen intrathecal injection)Effective 10/01/2024 - 09/30/2025 | Oct 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Qalsody (tofersen intrathecal injection)Effective 10/01/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Qalsody (tofersen)Effective 10/01/2023 - 09/30/2024 | Oct 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (Tofersen) | May 1, 2026 | Covered |
| Qalsody (Tofersen) – Commercial and Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Qalsody (Tofersen) – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (tofersen) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| State and School Employees' Health Insurance Plan - Qalsody (tofersen) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (tofersen) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Qalsody (tofersen) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (Qalsody) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (e.g., Qalsody) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Policy | Effective | Status of J1304 |
|---|---|---|
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Policy | Effective | Status of J1304 |
|---|---|---|
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Policy | Effective | Status of J1304 |
|---|---|---|
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Policy | Effective | Status of J1304 |
|---|---|---|
| QALSODY | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| QALSODY (TOFERSEN) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (Qalsody) | Aug 30, 2023 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (Qalsody); CP.PHAR.591 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (Qalsody) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Tofersen (Qalsody) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| 00854 tofersen (Qalsody) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (tofersen) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (tofersen) (PG151, Ver. 5) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (Tofersen) | May 1, 2026 | Covered |
| Policy | Effective | Status of J1304 |
|---|---|---|
| Qalsody (Tofersen) | May 1, 2026 | Covered |