sildenafil tablets — Medical Mutual

Initial criteria

• Patient has a diagnosis of PAH (WHO Group 1)
• Patient has had a right heart catheterization to confirm the diagnosis of PAH (WHO Group 1)
• Requested agent is prescribed by or in consultation with a cardiologist or pulmonologist
• If generic sildenafil suspension or Liqrev suspension is prescribed: (a) Patient has previously failed or is intolerant to generic 20 mg sildenafil tablets OR (b) Patient cannot swallow or has difficulty swallowing generic sildenafil 20 mg tablets OR (c) Patient requires administration of a dose that cannot be obtained with generic sildenafil 20 mg tablets
• If brand Tadliq is prescribed: (a) Patient has previously failed or is intolerant to Alyq or generic tadalafil 20 mg tablets OR (b) Patient cannot swallow or has difficulty swallowing Alyq or generic tadalafil 20 mg tablets OR (c) Patient requires administration of a dose that cannot be obtained with generic tadalafil 20 mg tablets

Approval duration

1 year