Chewtadzy (tadalafil chewable tablets) 5 mg — CareFirst (Caremark)
Erectile Dysfunction and Benign Prostatic Hyperplasia (ED/BPH)
Preferred products
- alfuzosin
- doxazosin
- silodosin
- tamsulosin
- terazosin
- dutasteride
- finasteride 5 mg
- Jalyn (dutasteride/tamsulosin)
Initial criteria
- Benign Prostatic Hyperplasia (BPH): Authorization may be granted when the requested drug is being prescribed for daily use for symptomatic benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) when ALL of the following are met: (1) The patient is age ≥ 18 years; AND (2) The patient meets ONE of the following: (a) The patient has experienced an inadequate treatment response to an alpha-blocker and/or a 5 alpha-reductase inhibitor (5-ARI); OR (b) The patient has experienced an intolerance to an alpha-blocker and/or a 5-ARI; OR (c) The patient has a contraindication that would prohibit a trial of an alpha-blocker and/or a 5-ARI.
- Erectile Dysfunction (ED): Authorization may be granted when the requested drug is being prescribed for erectile dysfunction when the patient is age ≥ 18 years.
Reauthorization criteria
- Benign Prostatic Hyperplasia (BPH): Authorization may be granted when the requested drug is being prescribed for daily use for symptomatic benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) when ALL of the following are met: (1) The patient is age ≥ 18 years; AND (2) The patient has achieved or maintained a positive clinical response to the requested drug.
- Erectile Dysfunction (ED): All patients (including new patients) requesting authorization for continuation of therapy must meet ALL initial authorization criteria.
Approval duration
36 months