Medicare AdvantagePrior AuthLow impact
Chenodal™ (chenodiol) (Revised)
Humana·Gastroenterology, General Surgery, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2015
We identified it
Jul 22, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for Chenodal (chenodiol) tablets used to treat radiolucent gallstones. The policy was updated on July 22, 2026, and requires prior authorization before dispensing. Coverage is limited to patients with radiolucent gallstones in well-opacifying gallbladders who are not surgical candidates and have failed or cannot tolerate ursodiol therapy. Patients with pre-existing liver disease are excluded.
Action Required
By the next pharmacy policy review cycle: Billing and pharmacy teams must verify this is the current Chenodal prior authorization policy by checking Humana's online portal at www.humana.com/PAL. For all new Chenodal requests from Medicare Advantage members, ensure prior authorization is obtained before dispensing. Verify patient meets all three approval criteria: (1) diagnosed radiolucent gallstones in well-opacifying gallbladder, (2) not a surgical candidate, and (3) previous treatment/contraindication/intolerance to ursodiol. Deny coverage if patient has pre-existing liver disease. Update pharmacy system templates to require documentation of these criteria for each PA request. Do not rely on printed versions of this policy.