Skip to content
The Policy VaultThe Policy Vault

Cialis (tadalafil tablets − Eli Lilly, generic)Cigna

High-Altitude Pulmonary Edema (HAPE), Treatment or Prevention

Initial criteria

  • Approve for 1 year in patients who meet BOTH of the following (A and B):
  • A) Patient has HAPE or a history of HAPE; AND
  • B) Patient has tried one other pharmacologic therapy for treatment or prevention of HAPE.

Approval duration

1 year