The ALS Association sent formal responses to Blue Cross Blue Shield of Illinois, New Mexico, Texas, Oklahoma, and Montana challenging their draft policies regarding coverage of Qalsody, approved by the FDA earlier this year for treatment of people living with ALS caused by the SOD1 gene mutation. These payers are all owned by the Health Care Service Corporation.
The draft policies consider the use of Qalsody “not medically necessary.” This is unacceptable as it has both biological and clinical benefit.
In letters also shared with the Centers for Medicare and Medicaid Services and the Veterans Administration, we called on these insurers to revise their policies to:
- Provide immediate coverage for Qalsody that is consistent with the FDA-approved indication and labeling, including in combination where appropriate.
- Avoid unnecessary delays in access to Qalsody caused by prior authorization, tiered/fail first/step therapy, or other deliberate and unnecessary barriers to access.
You can read the full letter here.