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PRIOR AUTHORIZATION POLICY Chenodal™ (chenodiol tablets Manchester Pharmaceuticals) To initiate a Coverage Review, Call[removed]
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Document Date: 2013-11-01 14:13:12

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City

Morgantown / Birmingham / /

Company

Manchester Pharmaceuticals Inc. / Axcan Pharma US Inc / Mylan Pharmaceuticals Inc. / /

Facility

Fort Collins / /

MedicalCondition

systemic disease / et al. Cerebrotendinous Xanthomatosis / high cholesterol / Chronic diarrhea / Cerebrotendinous Xanthomatosis / juvenile cataracts / radiolucent cholesterol gallstones / Gallstones / /

MedicalTreatment

elective surgery / surgery / /

NaturalFeature

Lorincz MT / /

Organization

FDA / /

Person

Arch Neurol / /

/

Position

metabolic specialist / /

Product

Page 2 REFERENCES Chenodal™ / URSO 250 / ursodiol / REFERENCES Chenodal™ tablets / URSO Forte / /

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