Sohonos (palovarotene) — United Healthcare

Initial criteria

• Diagnosis of fibrodysplasia ossificans progressiva (FOP)
• AND One of the following:
• (1) Both of the following: Patient is female AND age ≥ 8 years
• OR (2) Both of the following: Patient is male AND age ≥ 10 years
• AND Sohonos is being used to reduce the volume of new heterotopic ossification (HO)

Reauthorization criteria

• Documentation of positive clinical response to Sohonos therapy

Approval duration

12 months