Does UnitedHealthcare Cover Cialis (Tadalafil)?

How do you find out whether a plan pays for Cialis?

A plan's formulary tier and its utilization management rules, such as prior authorization and step therapy, decide what it pays, and those terms are set plan by plan. The formulary is the document that lists whether a specific product and strength is covered, which tier it sits on, and whether prior approval or a step through another drug is required before it is paid for. Check the current formulary entry for the exact product and strength on the prescription, then check the plan's benefits for what you would pay.

Which tadalafil product is the prescription for?

Cialis is a phosphodiesterase type 5 (PDE5) inhibitor approved for erectile dysfunction (ED), for the signs and symptoms of benign prostatic hyperplasia (BPH), and for ED together with BPH [1]. Drugs@FDA lists the 5, 10 and 20 mg Cialis tablets as prescription products and the 2.5 mg tablet as discontinued [2]. Generic tadalafil tablets are approved for the same ED and BPH uses [2].

The dose depends on the use. As needed for ED, Cialis starts at 10 mg before sexual activity and is taken no more than once a day. Once-daily use for ED starts at 2.5 mg and may increase to 5 mg, and BPH or ED with BPH is 5 mg once daily [1]. Knowing which use and strength the prescription names makes the formulary lookup straightforward.

Adcirca is a different product: tadalafil 20 mg tablets approved for pulmonary arterial hypertension (PAH), not for ED or BPH [3]. It has its own approved uses and dosing, so a formulary entry for Adcirca does not tell you how Cialis is covered [1][3].