dutasteride/tamsulosin — Medical Mutual
symptomatic benign prostatic hyperplasia (BPH)
Preferred products
- generic finasteride 5 mg
- generic dutasteride
Initial criteria
- Patient has an atypical diagnosis and/or unique patient characteristics which prevent use of all Step 1 agents OR
- Patient has a contraindication to all Step 1 agents OR
- Patient is continuing therapy with the requested Step 2 agent after being stable for ≥ 90 days AND meets ONE of the following:
- - Patient has ≥ 130 days of prescription claims history on file and claims history supports use of requested Step 2 agent for ≥ 90 days within a 130-day look-back period AND no generic equivalent available for the requested Step 2 product OR
- - Prescriber verifies patient has been receiving the requested Step 2 agent for ≥ 90 days via paid claims (not samples/coupons/waivers) AND no generic equivalent available for the requested Step 2 product
Approval duration
1 year