Sohonos (palovarotene) — Highmark

Initial criteria

• age ≥ 8 years if female OR age ≥ 10 years if male
• prescribed by or in consultation with an orthopedic or a provider who specializes in the treatment of FOP
• diagnosis of fibrodysplasia ossificans progressiva (FOP) with R206H mutation
• evidence of baseline heterotopic ossification

Reauthorization criteria

• prescriber attests that the member has experienced a reduction in the volume of new heterotopic ossification from baseline

Approval duration

12 months