Sohonos (palovarotene capsules) — Cigna

Initial criteria

• Patient meets ONE of the following (i or ii): i. Patient is female and age ≥ 8 years; OR ii. Patient is male and age ≥ 10 years; AND
• Patient has had a genetic test confirming a mutation in Activin A Type 1 Receptor (ACVR1) R206H consistent with a diagnosis of fibrodysplasia ossificans progressiva; AND
• Patient has heterotopic ossification as confirmed by radiologic testing (e.g., x-ray, computed tomography [CT], magnetic resonance imaging [MRI], or positron emission tomography [PET] scan); AND
• The medication is prescribed by or in consultation with an endocrinologist or physician who specializes in bone disease.

Approval duration

1 year