Summary
UnitedHealthcare Community Plan of Pennsylvania (Medicaid) added a medical policy for Pasatru (garetosmab-grts) for fibrodysplasia ossificans progressive (FOP), effective 2026-12-01. Initial therapy requires patients over 18, a FOP diagnosis, chart notes documenting clinical signs and symptoms, genetic testing confirming an ACVR1 mutation, prescribing by or in consultation with an FOP expert, dosing per FDA labeling, no combined use with Sohonos (palovarotene), and authorization for no more than 12 months; continuation requires documented positive clinical response with similar limits.
Get alerts when payers change rules like this one
We check UnitedHealthcare and other payers every day and email you when a change matches your specialty and state.
Get UnitedHealthcare alertsPolicy Monitoring is free. No card required.
What to do
Action · 3 steps
01By 2026-12-01: Billing team should confirm whether the practice treats patients with FOP who are covered under this Pennsylvania Medicaid plan, and if so, update the prior authorization tracker to add Pasatru requests with the required documentation (age, FOP diagnosis, chart notes and ACVR1 genetic test results, expert prescriber involvement, and a check that Sohonos is not used concurrently).
02Providers and front desk staff should be told to collect these records before ordering Pasatru so claims are submitted with complete support.
03Ongoing: Watch for the payer's next notice on Pasatru authorization requests and reauthorization timing.
Original notice
Pasatru™ (Garetosmab-Grts)
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Pasatru ™ (Garetosmab-Grts)LowEffective Dec 1, 2026 · Medical Benefit Drug PolicyPasatru™ (Garetosmab-Grts)LowEffective Dec 1, 2026 · Medical PolicyPasatru™ (Garetosmab-Grts)LowEffective Dec 1, 2026 · Medical Benefit Drug PolicyPasatru™ (Garetosmab-Grts)LowEffective Dec 1, 2026 · Medical Benefit Drug PolicyBrowse every UnitedHealthcare change in the policy list