Cialis (tadalafil) 2.5 and 5 mg tablets Prior Approval Criteria
Prior authorization policy for pharmacy benefit coverage of Cialis (tadalafil) 2.5 mg and 5 mg tablets, specifying recommended authorization criteria, approved indications, durations, automation rules, documentation requirements, and conditions not recommended for approval. Applies to plans that do not cover Cialis for erectile dysfunction.
No material policy changes — coverage criteria and recommendations remain as previously stated.
Coverage Summary
Cialis (tadalafil) 2.5 mg and 5 mg tablets prior authorization. This policy outlines prior authorization criteria for tadalafil 2.5 mg and 5 mg tablets for non-ED coverage. The primary covered indication is treatment of Benign Prostatic Hyperplasia (BPH) (ICD-10: N40*) and authorization is recommended for those who meet the specified criteria. This prior authorization applies to plans that do not cover Cialis for erectile dysfunction; erectile dysfunction (ED) is excluded from the scope of this prior authorization.