Cialis Approved for Treatment of Benign Prostatic Hyperplasia
Note: This is a correction to a previously communicated article, which incorrectly stated the new requirement applied to SHP.
The U.S. Food and Drug Administration (FDA) recently approved Cialis, a drug normally used to treat erectile dysfunction (ED), to also treat the signs and symptoms of benign prostatic hyperplasia (BPH, also known as enlarged prostate), as well as a combination of BPH and ED when the conditions coincide.
Effective December 1, 2011, prior authorization is required for this drug for treatment of BPH. Blue Cross and Blue Shield of North Carolina (BCBSNC) members whose plans have the standard benefit limitation of four pills or units per 30 days for medications used to treat ED only (or ASO groups with different benefit limits) will still receive Cialis per those benefit guidelines.
Are all forms of Cialis approved for this new indication?
No, only the 5mg once-daily dosage form of Cialis was approved to treat the signs and symptoms of BPH based on the study guidelines. Therefore, if an eligible BCBSNC member is approved for this medication for this diagnosis, the maximum dosage approved is 30 pills per 30 days. Members should be seen by an urologist to ensure they are receiving the appropriate medication and to initiate the prior authorization process, outlined below.
How do I obtain prior authorization for this drug for BPH on behalf of my BCBSNC patients?
Complete and submit the prior authorization fax form for Cialis, which can be found online on the Prior Review page via the Provider portal on www.bcbsnc.com. If certain criteria are met, the member will be initially approved for a three-month period of Cialis. After the three-month trial, and if you are able to document progress, the medication may be approved for an additional 12 months, and subject to approval every subsequent 12 months.
This new requirement applies to all commercial BCBSNC members. It does not apply to Blue Medicare, *State Health Plan or the Federal Employee Program (FEP).
*BCBSNC originally communicated the new requirement applied to State Health Plan.