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ChewtadzyCareFirst (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