Summary
UnitedHealthcare Community Plan of New Jersey added a Medicaid medical benefit drug policy for Pasatru (garetosmab-grts) for fibrodysplasia ossificans progressiva (FOP), effective 2026-12-01. Initial therapy requires an age over 18, an FOP diagnosis, supporting chart notes and ACVR1 genetic testing, prescribing by or in consultation with an FOP expert, FDA-labeled dosing, no combination with Sohonos (palovarotene), and authorization for no more than 12 months; continuation requires documented positive response and renewal for no more than 12 months.
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What to do
Action · 2 steps
01By 2026-12-01: Billing team should confirm with providers that Pasatru orders for New Jersey Community Plan Medicaid members meet the new criteria (age over 18, FOP diagnosis, ACVR1 genetic test results, FOP expert prescriber, FDA-labeled dosing, no concurrent Sohonos) and obtain prior authorization before administration.
02Providers and front desk staff should be told to collect chart notes and genetic testing reports for the authorization file, and the billing team should track the 12-month initial and reauthorization windows in the prior auth tracker.
Original notice
Pasatru™ (Garetosmab-Grts)
uhcprovider.com · Always check the source before changing claims.
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