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Does State Medicaid Cover Cialis (Tadalafil)? A State-by-State Guide

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At a glance

  • Who decides / Each state Medicaid program, through its drug list or managed care formulary
  • Prescription status / Cialis 5, 10 and 20 mg tablets are prescription products [2]
  • Cialis approved / November 21, 2003, as a new molecular entity [2]
  • Cialis indications / ED, BPH signs and symptoms, and ED with BPH [1]
  • 2.5 mg tablet / Listed as discontinued in Drugs@FDA [2]
  • Adcirca / A separate prescription tadalafil 20 mg product, approved May 22, 2009 [3]
  • Generic tadalafil 20 mg / More than ten generic tablets listed by FDA as equivalent to Adcirca [3]

Does Medicaid cover Cialis or generic tadalafil?

Medicaid is a joint federal-state program, and each state sets its own pharmacy benefit and its own drug list. Whether Cialis or generic tadalafil is listed, and with what restrictions, is shown in the current state Medicaid drug list or, for members of a managed care plan, the plan formulary.

What the FDA approval covers

Cialis (tadalafil tablets) was approved on November 21, 2003 as a new molecular entity [2]. The label lists three uses: erectile dysfunction, the signs and symptoms of benign prostatic hyperplasia, and both conditions together [1]. If Cialis is used with finasteride to start BPH treatment, the label recommends use for up to 26 weeks [1].

Drugs@FDA lists the 5, 10 and 20 mg tablets as prescription products and the 2.5 mg tablet as discontinued [2]. For BPH and for ED with BPH, the label dose is 5 mg once daily; for ED taken as needed it starts at 10 mg [1].

Adcirca is a different tadalafil product

Adcirca is a separate prescription tadalafil 20 mg tablet product approved on May 22, 2009 [3]. It is approved for PAH, not for ED or BPH, so a coverage question about Adcirca is a question about a different prescription. The Cialis label says combining Cialis with other PDE5 inhibitors or other ED treatments has not been studied [1].

Generic tadalafil

FDA lists more than ten generic tadalafil 20 mg tablet applications as therapeutically equivalent to Adcirca [3]. That listing is for the Adcirca product, and it does not by itself say whether a state Medicaid program covers a given tadalafil tablet.

Frequently asked questions

Does Medicaid cover Cialis?
Coverage is set by each state Medicaid program. The state drug list or managed care formulary shows whether Cialis or generic tadalafil is listed and what restrictions apply. Cialis itself is a prescription medicine approved for ED and BPH [1][2].
What is Cialis approved for?
Cialis is FDA-approved for erectile dysfunction, the signs and symptoms of benign prostatic hyperplasia, and both together [1]. If it is started with finasteride for BPH, the label recommends use for up to 26 weeks [1].
Is Adcirca covered the same way as Cialis?
They are different products. Adcirca is a separate prescription tadalafil 20 mg tablet product approved on May 22, 2009 for PAH [3]; Cialis is approved for ED and BPH [1]. Each is its own prescription, and each state sets its own drug list.
Does Medicaid cover tadalafil for BPH as well as ED?
Cialis is approved for BPH signs and symptoms and for ED with BPH at 5 mg once daily [1]. Whether a given use is covered is a state drug list decision.
Is Cialis a prescription medicine?
Yes. Drugs@FDA lists the Cialis 5, 10 and 20 mg tablets as prescription products [2].

References

  1. U.S. National Library of Medicine, DailyMed. Cialis (tadalafil) tablets, Lilly prescribing information. Cialis (tadalafil) tablets, Lilly label
  2. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
  3. Drugs@FDA: FDA-Approved Drugs. Drugs@FDA: FDA-Approved Drugs
Evidence overview for Does State Medicaid Cover Cialis (Tadalafil)? A State-by-State Guide