Chenodal (chenodiol) — Highmark
radiolucent gallstones in well-opacifying gallbladders (small <15 mm or floatable)
Preferred products
- ursodiol
Initial criteria
- age ≥ 18 years
- treatment of small (<15 mm) or floatable radiolucent gallstones (ICD-10: K80)
- therapeutic failure, contraindication, or intolerance to plan-preferred ursodiol therapy
Reauthorization criteria
- member has experienced at least partial dissolution of gallstones
Approval duration
initial up to 12 months; reauthorization up to 12 months (no approval beyond 24 months)