UnitedHealthcare added Pasatru (garetosmab-grts) to its Review at Launch program for new-to-market medications, so some commercial members may not be eligible for coverage at this time. Pasatru is covered as medically necessary for fibrodysplasia ossificans progressiva (FOP) when initial-therapy criteria are met, including patient age over 18, FOP diagnosis with clinical signs and ACVR1 mutation documentation, prescriber consultation with an FOP expert, no combination with Sohonos (palovarotene), dosing per FDA labeling, and authorization of no more than 12 months; continuation requires documented positive response and the same safeguards with reauthorization of no more than 12 months.
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01By 2026-12-01: Billing team and providers should confirm whether each UnitedHealthcare commercial patient prescribed Pasatru falls under the Review at Launch program and review the Medical Benefit Drug Policy titled Review at Launch for New to Market Medications to understand possible eligibility limits.
02Before scheduling or administering Pasatru for an initial-therapy patient, obtain the authorization documentation the policy requires: age over 18, FOP diagnosis, chart notes and laboratory values showing clinical signs, ACVR1 genetic testing, prescriber or consultation with an FOP expert, and confirmation the patient is not on Sohonos.
03Front desk staff should flag FOP patients on Pasatru in the prior auth tracker, and the billing team should set up continuation requests with documented clinical response and 12-month reauthorization timing.
04Claims without the required documentation may be denied, so the billing team should attach the records to the request before submission.
Original notice
Pasatru™ (Garetosmab-Grts)
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