UnitedHealthcareMedicaid · Prior Auth · Medical Benefit Drug Policy · TN · Genetics, Pharmacy, Endocrinology +1 moreLow impact
Pasatru ™ (Garetosmab-Grts)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Tennessee added a Medicaid medical benefit drug policy for Pasatru (garetosmab-grts), effective 2026-12-01, covering treatment of fibrodysplasia ossificans progressiva (FOP). Initial therapy requires patients over 18, a confirmed FOP diagnosis, chart notes and ACVR1 genetic testing, use to reduce new heterotopic ossification lesions and flare-ups, no combination with Sohonos (palovarotene), prescribing by or in consultation with an FOP expert, dosing per FDA labeling, and initial authorization of no more than 12 months. Continuation requires documented positive clinical response and the same conditions, with reauthorization of no more than 12 months.
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01By 2026-12-01: Billing team and providers should, before scheduling Pasatru for Tennessee Community Plan Medicaid members, confirm the diagnosis of FOP, the ACVR1 genetic test result, the expert prescriber and the absence of Sohonos combination are documented in the chart, since claims without this documentation will be denied under the policy's criteria.
02Front desk staff should be told to request the listed chart notes and laboratory values when scheduling.
03In the prior authorization tracker, record the 12-month initial and reauthorization limits and calendar reauthorization submissions with documented clinical response.
Original notice
Pasatru ™ (Garetosmab-Grts)
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