Cholbam (cholic acid) — CareFirst (Caremark)
Bile acid synthesis disorders due to single enzyme defects (SEDs)
Initial criteria
- Diagnosis confirmed by mass spectrometry or other biochemical testing, genetic testing, or enzyme assay
- Member has liver dysfunction (elevated transaminases, elevated bilirubin, or presence of cholestasis) at baseline
Reauthorization criteria
- Member is currently receiving the requested medication through a paid pharmacy or medical benefit
- Member has achieved and maintained improvement in liver function from baseline (reduced transaminases, reduced bilirubin, no evidence of cholestasis on liver biopsy)
Approval duration
Initial: 6 months; Reauthorization: 12 months