Pharmacy Prior Authorization Criteria

Erectile Dysfunction Medications

Indications for Prior Authorization

Cialis (tadalafil)

• For diagnosis of Benign Prostatic Hyperplasia (BPH) and Erectile Dysfunction (ED)
  Indicated for the treatment of erectile dysfunction (ED), the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH) and for the treatment of erectile dysfunction (ED) and the signs and symptoms of BPH (ED/BPH).

  Limitation of use: If Cialis is used with finasteride to initiate BPH treatment, such use is recommended for up to 26 weeks because the incremental benefit of Cialis decreases from 4 weeks until 26 weeks, and the incremental benefit of Cialis beyond 26 weeks is unknown.

Criteria

Brand Cialis 2.5 mg, Brand Cialis 5 mg, Generic tadalafil 2.5 mg, or Generic tadalafil 5 mg

Non-Formulary / Prior Authorization

Length of Approval: 12 Month(s)

• Diagnosis of benign prostatic hyperplasia (BPH) [A]
AND
• The request is for one of the following: [B]
• Cialis (tadalafil) 2.5 mg
• Cialis (tadalafil) 5 mg

P & T Revisions

2024-07-03, 2023-07-28, 2022-06-29, 2021-06-18, 2020-06-03

References

1. Cialis prescribing information. Eli Lilly and Company. Indianapolis, IN. April 2023.

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Revision History

• 2024-07-03: 2024 Annual Review. No criteria changes. Background updates.
• 2023-07-28: Annual Review
• 2022-06-29: Annual Review
• 2021-06-18: Annual Review
• 2020-06-03: Annual Review

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