CIALIS (tadalafil)
SELF ADMINISTRATION - ORAL
Indications for Prior Authorization:
- Cialis® for daily use: Benign prostatic hyperplasia (BPH)
Patients must meet the following criteria for the indication(s) above:
- Cialis® for daily use:
- Diagnosis of benign prostatic hyperplasia (BPH) and treatment failure on two or more of the following FDA-approved drug classes for BPH:
- A 5 alpha-reductase inhibitor: Finasteride (Proscar®), dutasteride (Avodart®), AND
- An alpha-blocker: terazosin (Hytrin), doxazosin (Cardura®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), and silodosin (Rapaflo®)
- Drugs may be tried individually or in combination therapy
- Diagnosis of benign prostatic hyperplasia (BPH) and treatment failure on two or more of the following FDA-approved drug classes for BPH:
The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P&T Committee:
- Peripheral vasoconstriction
- Patients taking nitrates
- All non-FDA approved uses not listed in the approved indications
Dosing:
- Cialis®: 5 mg daily for BPH
- For male ED (erectile dysfunction), Cialis® is limited to 8 tablets per 30 day supply at a retail pharmacy or 24 tablets per 90 day supply at a mail order pharmacy
Approval:
- One year
Last review date: August 10, 2020