Generic avanafil tablets — Medical Mutual
Erectile dysfunction with benign prostatic hyperplasia (Cialis only)
Preferred products
- Generic sildenafil citrate tablets
- Generic tadalafil tablets
Initial criteria
- Atypical diagnosis and/or unique patient characteristics which prevent use of all preferred agents OR
- Contraindication to all preferred agents OR
- Patient is continuing therapy with the requested non-preferred agent after being stable for at least 90 days AND meets ONE of the following:
- Patient has at least 130 days of prescription claims history and has received the requested non-preferred agent for 90 days within that time AND there is no generic equivalent available for the requested nonpreferred product OR
- When 130 days of claims history is unavailable, prescriber verifies that the patient has been receiving the requested non-preferred agent for 90 days with paid claims AND there is no generic equivalent available for the requested nonpreferred product
Approval duration
1 year