Cholbam (cholic acid) — Highmark
Bile acid synthesis disorders due to single enzyme defect
Initial criteria
- age ≥ 3 weeks
- Diagnosis of bile acid synthesis disorder (ICD-10: E78.7, excluding E78.71) due to a single enzyme defect confirmed by one of the following: abnormal urinary bile acid detected by mass spectrometry (e.g., FAB-MS) OR other biochemical or genetic testing
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
Initial: up to 3 months; Reauthorization: up to 12 months