Currentmedical mutual - ohioPolicy N/A

Ctexli (chenodiol) — Coverage Criteria for Cerebrotendinous Xanthomatosis

Defines prior authorization, coverage criteria, and approval durations for Ctexli (chenodiol tablets) for treatment of cerebrotendinous xanthomatosis; applies to pharmacy benefit claims under the payer.

Policy Summary

Payermedical mutual - ohio

PolicyCtexli (chenodiol) — Coverage Criteria for Cerebrotendinous Xanthomatosis

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective DateN/A

Next Review DateJan 15, 2027

Key ActionSubmit prior authorization with specialist consultation or prescription and evidence of elevated serum cholestanol to support coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 yrInitial approval duration

1 yrExtended approval duration

1Indication approved

2Not recommended conditions

Coverage Criteria for Ctexli (chenodiol)

Cerebrotendinous xanthomatosis — Initial/Extended Approval

Policy Summary

Payermedical mutual - ohio

PolicyCtexli (chenodiol) — Coverage Criteria for Cerebrotendinous Xanthomatosis

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective DateN/A

Next Review DateJan 15, 2027

Key ActionSubmit prior authorization with specialist consultation or prescription and evidence of elevated serum cholestanol to support coverage.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Covered when ALL of the following are met

Cerebrotendinous Xanthomatosis initial approval: 1) Patient has a laboratory test demonstrating elevated serum cholestanol levels; AND 2) The medication is prescribed by or in consultation with a geneticist, neurologist, ophthalmologist, metabolic specialist who treats patients with cerebrotendinous xanthomatosis or a specialist who focuses in the treatment of cerebrotendinous xanthomatosis.

Approve for 1 year initial; extended approval 1 year

Concomitant use of Ctexli (chenodiol) with Cholbam (cholic acid) is not recommended because no efficacy data support combined therapy. Requests for coverage of combination therapy may be denied.

Coverage is not recommended for situations that are not expressly listed in the Recommended Authorization Criteria. Requests for uses outside those criteria will be reviewed on a case‑by‑case basis and may be denied when evidence is insufficient.

Uses of Ctexli that lack evidence of efficacy or that raise potential safety concerns are not recommended for approval and may be considered investigational/experimental. Such requests can be denied, and the Company may require additional documentation to support medical necessity.

Initial Therapy for CTX

Initial approval for CTX when criteria met

Initial therapy: Elevated serum cholestanol AND specialist prescription or consultation. Initial approval duration: 1 year.

Initial approval duration: 1 year

Reauthorization and Continuation Criteria

Reauthorization / Continuation

Reauthorization requires demonstration of response to therapy unless otherwise noted.

Extended approval conditions: Extended approval is 1 year; reauthorization requires response to therapy unless otherwise specified.

Extended approval duration: 1 year

Coding and Diagnostic Support

inv-05: Laboratory test — elevated serum cholestanol levels

TestLaboratory test demonstrating elevated serum cholestanol levels

ContextRequired as part of initial approval for cerebrotendinous xanthomatosis (CTX)

Role in criteriaOne of two mandatory criteria that must be met for 1-year approval

Provider Actions, Requirements, and Restrictions

Prior Authorization

Prior Authorization Recommended

Prior authorization is recommended for Ctexli. Initial approval requires the drug be prescribed by or in consultation with a physician who specializes in the condition being treated.

Prior authorization recommended for pharmacy benefit coverage
Initial approval requires specialist prescription or consultation

Denial Risk

Combination Therapy Restriction

Combination therapy with Cholbam (cholic acid capsules) is not recommended. There are no efficacy data available to support concomitant use; requests for combination therapy may be denied.

Combination therapy with Cholbam (cholic acid) not supported by efficacy data
Concomitant use may be denied

Documentation Required

Documentation Required on Request / Denial Triggers

The Company may request additional documentation to support medical necessity. Documentation may include patient records, test results, and provider credentials. The Company may deny reimbursement if the drug or services are determined to be not medically necessary, investigational/experimental, not within criteria, or lacking required documentation.

Documentation may include patient records, test results, and/or provider credentials
Reimbursement may be denied if services are not medically necessary, investigational/experimental, outside scope of benefits, or lack documentation

Background on Chenodiol (Ctexli)

Chenodiol (Ctexli) is a naturally occurring bile acid indicated for the treatment of cerebrotendinous xanthomatosis (CTX) in adults. Treatment typically requires involvement of a specialist experienced in CTX for diagnosis and monitoring.

Definitions and Diagnostic Criteria

inv-11: Cerebrotendinous xanthomatosis (CTX) — rare metabolic disorder; diagnosis supported by elevated serum cholestanol and specialist evaluation.

DefinitionCerebrotendinous xanthomatosis (CTX) is a rare metabolic disorder treated with chenodiol (Ctexli).

Diagnostic supportDiagnosis supported by a laboratory test demonstrating elevated serum cholestanol levels

Specialist involvementMedication must be prescribed by or in consultation with a geneticist, neurologist, ophthalmologist, metabolic specialist who treats CTX patients, or a specialist who focuses in CTX treatment

TreatmentCtexli (chenodiol) is indicated for treatment of CTX in adults

Step Therapy / Combination Restrictions

Restriction	Details
Do not combine with Cholbam (cholic acid)	Concomitant use with Cholbam (cholic acid capsules) is not recommended: there are no efficacy data available to support concomitant use.