Tricare requires prior authorization for Cialis for erectile dysfunction only under specific circumstances. Generally, this applies when other, less costly treatments have been tried and failed.
Situations Requiring Prior Authorization
Prior authorization is typically needed if you have not first tried and failed alternative, less expensive treatment options such as phosphodiesterase-5 inhibitors (PDE5i) other than tadalafil (Cialis) or other proven therapies. Your physician will need to document these attempts in your medical records.
Additionally, certain clinical scenarios might necessitate prior authorization. For example, if you have a significant cardiovascular condition, a history of non-arteritic anterior ischemic optic neuropathy (NAION), or other factors that increase the risk of adverse effects from Cialis, prior authorization might be required. Your doctor can explain your specific case.
Documentation Required for Prior Authorization
To ensure a smooth approval process, your doctor should include comprehensive information in your prior authorization request. This usually includes a detailed medical history, documented failure of less costly treatment options, and a clear explanation of why Cialis is the most appropriate treatment for your specific condition.
| Diagnosis | Precise diagnosis of erectile dysfunction and any related conditions |
| Treatment History | Detailed record of prior treatments and their outcomes (including dosages and duration) |
| Justification | Clear explanation of why Cialis is medically necessary and appropriate for your situation |
| Patient Information | Complete contact and identifying details |
Contacting Tricare
For detailed guidelines and specific requirements for prior authorization, directly contact your Tricare provider or visit the official Tricare website. They can furnish you with the most current information and forms needed.
