Summary
UnitedHealthcare Community Plan of Kentucky added a medical benefit drug policy for Pasatru (garetosmab-grts) under its Medicaid plan in Kentucky, effective 2026-12-01. Initial therapy requires the patient to be over 18, a fibrodysplasia ossificans progressiva (FOP) diagnosis, supporting chart notes and genetic confirmation of an ACVR1 mutation, prescribing by or with an FOP expert, dosing per FDA labeling, and no combined use with Sohonos (palovarotene), with authorizations up to 12 months; continuation requires documented positive response and the same conditions.
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What to do
Action · 3 steps
01Before 2026-12-01: Billing team should add Pasatru to the prior authorization tracker for UnitedHealthcare Community Plan of Kentucky Medicaid members and build a checklist requiring chart notes, genetic test results, prescriber specialty and dosing confirmation before the drug is scheduled.
02Providers and front desk staff should be told that initial and continuation requests need these documents and that the request must confirm no concurrent Sohonos use.
03Claims without prior authorization will be denied, so verify authorization status in the tracker before billing, and watch for the payer's next bulletin for any changes to the 12-month authorization limits.
Original notice
Pasatru™ (Garetosmab-Grts)
uhcprovider.com · Always check the source before changing claims.
Related changes
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