Ctexli (chenodiol) — Highmark

Initial criteria

• age ≥ 18 years
• prescriber is a specialist who focuses on the treatment of CTX or is acting in consultation with such a specialist
• diagnosis of CTX confirmed with genetic testing (ICD-10: E75.5)

Reauthorization criteria

• member experiences improvement in one of the following: normalization of elevated serum or urine 23S-pentol (bile alcohols)
• OR normalization of elevated serum cholestanol levels
• OR improvement in neurologic and psychiatric symptoms (dementia, pyramidal tract, and cerebellar symptoms)

Approval duration

initial up to 12 months; reauthorization up to 12 months