Adcirca — Medica
pulmonary arterial hypertension (WHO Group I)
Preferred products
- generic tadalafil tablets (20 mg)
- Alyq
Initial criteria
- Patient meets the standard Pulmonary Arterial Hypertension – Phosphodiesterase Type 5 Inhibitors Prior Authorization Policy criteria
- Patient has tried one Preferred Product (generic tadalafil tablets 20 mg or Alyq)
Reauthorization criteria
- Patient continues to meet the Pulmonary Arterial Hypertension – Phosphodiesterase Type 5 Inhibitors Prior Authorization Policy criteria
Approval duration
1 year