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
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

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