UnitedHealthcare added Pasatru (garetosmab-grts) to its Review at Launch program for Exchange plans, effective 2026-12-01, so some members may not be eligible for coverage at this time. The policy covers Pasatru for fibrodysplasia ossificans progressiva (FOP) when initial therapy requires age over 18, an FOP diagnosis, documented clinical signs, ACVR1 genetic testing, prescribing by or in consultation with an FOP expert, FDA-labeled dosing, no combination with Sohonos (palovarotene), and initial authorization of no more than 12 months; continuation requires documented positive response with reauthorization for no more than 12 months.
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01By 2026-12-01: Billing team and providers should review Review at Launch eligibility for Pasatru before scheduling or ordering it for Exchange members, and confirm with the payer whether a given member is eligible during the program.
02Before scheduling Pasatru for FOP: Obtain prior authorization with chart notes documenting FOP signs and symptoms, ACVR1 genetic testing results, FOP expert involvement, dosing per FDA labeling, and confirmation of no concurrent Sohonos use, in the prior auth tracker.
03Update charge entry and claim documentation so requests for initial therapy and continuation (with documented positive response) carry the required records.
04Claims without prior auth will be denied.
05Front desk staff should flag Exchange members prescribed Pasatru so reauthorization is calendared within 12 months.
Original notice
Pasatru™ (Garetosmab-Grts)
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