Summary
UnitedHealthcare Community Plan of New Mexico added a medical policy for Pasatru (garetosmab-grts) for fibrodysplasia ossificans progressiva (FOP) in Medicaid members, effective 2026-12-01. Initial therapy requires patients over 18, an FOP diagnosis, chart notes and genetic testing confirming an ACVR1 mutation, prescribing by or with an FOP expert, dosing per FDA labeling, no combination with Sohonos, and authorization for no more than 12 months; continuation requires documented positive response and reauthorization for no more than 12 months.
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What to do
Action · 3 steps
01By 2026-12-01: Billing team should add this policy to the New Mexico Medicaid prior authorization tracker for Pasatru requests.
02Before scheduling or dispensing Pasatru for these members, the practice should confirm the patient is over 18, has the FOP diagnosis and ACVR1 genetic test results, and that the prescriber is an FOP expert or works with one; front desk and provider staff should be told to collect and attach chart notes and laboratory and genetic testing records to the request.
03Claims for Pasatru without the required prior authorization will be denied, so the team should track the 12-month authorization and reauthorization dates and gather documented clinical response for continuation requests.
Original notice
Pasatru™ (Garetosmab-Grts)
uhcprovider.com · Always check the source before changing claims.
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