Phosphodiesterase-5 (PDE5) inhibitors quantity limit for erectile dysfunction

Coverage decision

Effective 7/1/2022

When prescribed to treat accepted erectile dysfunction, coverage of PDE5 inhibitors is limited to generic formulations at a maximum of 8 tablets per 30-day supply, except for formulations which have FDA-approved indication for daily dosing.

Limited to maximum of 8 tablets per 30 days:

• Sildenafil – all strengths
• Tadalafil – 10 & 20mg tablets
• Vardenafil – all strengths

Limited to maximum of 30 tablets per 30 days:

• Tadalafil – 2.5 & 5mg tablets