Pasatru (garetosmab-grts) has been added to the Review at Launch program for Surest members, effective 2026-12-01, so some members may not be eligible for coverage of this medication. Coverage is medically necessary only when specified criteria are met for initial therapy (patient over 18, FOP diagnosis with documented clinical signs and ACVR1 genetic testing, use to reduce new heterotopic ossification lesions and flare-ups, not combined with Sohonos, prescribed by or with an FOP expert, dosing per FDA labeling, authorization up to 12 months) and continuation (documented positive response with the same prescriber and dosing conditions, reauthorization up to 12 months).
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01By 2026-12-01: Billing team and providers should review the Review at Launch for New to Market Medications policy referenced in the Surest bulletin to understand how Pasatru requests are handled for members.
02Before scheduling or ordering Pasatru for Surest members, have the ordering provider confirm the initial or continuation criteria are documented in the chart (age over 18, FOP diagnosis, clinical signs, ACVR1 genetic test report, FOP expert involvement, no concurrent Sohonos, FDA-labeled dosing), and get prior authorization in the prior auth tracker; claims submitted without the required authorization and documentation are likely to be denied.
03Front desk staff should be told to flag Pasatru orders for Surest members so the authorization step happens before the first dose.
Original notice
Pasatru™ (Garetosmab-Grts)
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