CurrentCignaPolicy N/A

Sildenafil (Viagra) prior authorization

This policy defines prior authorization requirements and coverage criteria for sildenafil (Viagra and generics) under Cigna-administered health benefit plans, including FDA-approved and selected off-label uses with supporting evidence.

Policy Summary

PayerCigna

PolicySildenafil (Viagra) prior authorization

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateNov 6, 2024

Key ActionObtain prior authorization for prescription benefit coverage of sildenafil; approvals are generally for 1 year.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6Covered uses

1 yearTypical approval duration

NCApplicable state

No criteria changesRevision notes

Coverage and Medical Necessity Criteria

Approved Indications and Supported Uses

Viagra (sildenafil tablets) is covered as medically necessary when criteria for an FDA-approved indication or specified supported uses are met.

Erectile Dysfunction (FDA-approved): Approve for 1 year.

FDA-approved indication

Benign Prostatic Hyperplasia (supported use)

ONE of: A) Patient has tried an alpha1 (α1) blocker (examples: doxazosin, terazosin, tamsulosin, alfuzosin).
ONE of: B) Patient has tried a 5α-reductase inhibitor (examples: finasteride, dutasteride).

High-Altitude Pulmonary Edema (HAPE) Treatment or Prevention

Policy Summary

PayerCigna

PolicySildenafil (Viagra) prior authorization

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateNov 6, 2024

Key ActionObtain prior authorization for prescription benefit coverage of sildenafil; approvals are generally for 1 year.

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.

Prior Authorization, Step Therapy, and Prescribing Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for prescription benefit coverage of sildenafil. Approvals are time-limited as noted below. Because of the specialized skills required for diagnosis, evaluation, and monitoring, some approvals require sildenafil to be prescribed by or in consultation with a specialist in the treated condition (see individual indications).

Prior authorization required for all sildenafil requests.
Approvals provided for the duration specified per indication (generally 1 year).
Specialist prescribing or consult may be required for certain indications (e.g., radical prostatectomy rehabilitation requires urologist involvement).

Step Therapy

Step Therapy / Trial of Alternatives

For certain non-FDA–approved but supported indications, a trial of specified alternative therapies is required prior to approval.

Benign prostatic hyperplasia: require trial of an alpha1 blocker (examples: doxazosin, terazosin, tamsulosin, alfuzosin) OR a 5α-reductase inhibitor (examples: finasteride, dutasteride).
High-altitude pulmonary edema (HAPE): patient must have tried one other pharmacologic therapy for treatment or prevention (examples: nifedipine, salmeterol, dexamethasone, acetazolamide, tadalafil).
Raynaud's phenomenon: require trial of a calcium channel blocker (examples: amlodipine, felodipine, nifedipine) OR documentation that a calcium channel blocker is contraindicated.

Note

Specialist Prescribing / Consultation

Specialist involvement is required or recommended for some indications due to the need for specialty evaluation, diagnosis, or monitoring.

Prophylaxis after radical prostatectomy (early penile rehabilitation): medication must be prescribed by or in consultation with a urologist.
Other indications may require specialist prescribing or consultation based on clinical judgment and safety monitoring needs.

Denial Risk

Non‑Listed Indications — Not Covered

Requests for uses not listed in the Recommended Authorization Criteria are considered experimental, investigational, or unproven and are not recommended for coverage. Criteria will be updated as new published data become available.

Coverage is not recommended for any indications not explicitly listed in the authorization criteria.
If a requested use is not listed, the request will be evaluated as experimental/investigational and is expected to be denied.

Background and Context

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor primarily indicated for the treatment of erectile dysfunction. Sildenafil tablets (marketed as Viagra and generics) have also been studied and used in other conditions; for example, sildenafil formulations are approved for pulmonary arterial hypertension (Revatio), and evidence has evaluated its use for benign prostatic hyperplasia–related lower urinary tract symptoms, high-altitude pulmonary edema (HAPE), post‑radical prostatectomy penile rehabilitation, and Raynaud’s phenomenon.

OpenPayer

Sildenafil (Viagra) prior authorization

Coverage and Medical Necessity Criteria

Covered Products and Codes

Prior Authorization, Step Therapy, and Prescribing Requirements

Background and Context

Definitions and Drug Class