Chewtadzy — 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
- Patient age ≥ 18 years
- For Benign Prostatic Hyperplasia (BPH) with or without Erectile Dysfunction (ED): ALL of the following must be met:
- — The patient is being prescribed the requested drug for daily use for symptomatic BPH (signs and symptoms may include incomplete emptying, weak stream, straining, urinary frequency, intermittency, or urgency)
- — The patient has experienced an inadequate treatment response to an alpha-blocker and/or a 5 alpha-reductase inhibitor (5-ARI) (examples: alfuzosin, doxazosin, silodosin, tamsulosin, terazosin, dutasteride, finasteride 5 mg, Jalyn [dutasteride/tamsulosin]) OR
- — The patient has experienced an intolerance to an alpha-blocker and/or a 5 alpha-reductase inhibitor (5-ARI) (same examples as above) OR
- — The patient has a contraindication that would prohibit a trial of an alpha-blocker and/or a 5 alpha-reductase inhibitor (5-ARI) (same examples as above)
- For Erectile Dysfunction (ED): The patient is 18 years of age or older.
Reauthorization criteria
- For Benign Prostatic Hyperplasia (BPH) with or without Erectile Dysfunction (ED):
- — Patient age ≥ 18 years
- — Patient has achieved or maintained a positive clinical response to the requested drug
- For Erectile Dysfunction (ED): All patients (including new patients) requesting continuation of therapy must meet all initial authorization criteria.
Approval duration
36 months