Medicare AdvantagePrior AuthLow impact
Sohonos® (palovarotene) (Revised)
Humana·Rheumatology, Genetics, Pediatrics·Medicare Advantage
Effective date
Jan 24, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Sohonos (palovarotene) capsules used to treat Fibrodysplasia Ossificans Progressiva (FOP). Coverage requires specific age criteria (8+ for females, 10+ for males), confirmed FOP diagnosis, and prescription by an experienced FOP provider.
Action Required
Immediately: Update prior authorization workflows for Sohonos (palovarotene) prescriptions for Humana Medicare Advantage members. Verify patient meets age requirements (8+ years for females, 10+ years for males), confirm FOP diagnosis, and ensure prescriber has FOP management experience before submitting prior auth requests. Document all three criteria in authorization requests to avoid denials.