Is Tadalafil Covered by Medicare Part D?

When is tadalafil covered by Medicare Part D?

Medicare Part D may cover tadalafil when the prescription meets the definition of a Part D drug and your specific plan covers it. In practical terms, this usually means:

The drug is on your plan’s formulary, which is the plan’s list of covered drugs.
The prescription is for a covered medical use.
You meet any plan requirements, such as prior authorization or quantity limits.

Tadalafil has FDA-approved uses that include erectile dysfunction, signs and symptoms of benign prostatic hyperplasia, and pulmonary arterial hypertension in certain tadalafil products. Coverage depends on the indication and the Part D plan’s rules.

Is tadalafil covered for erectile dysfunction?

Usually, no. CMS guidance treats erectile dysfunction drugs as excluded from basic Medicare Part D coverage when they are used for sexual or erectile dysfunction. This means a standard Part D benefit generally will not pay for tadalafil if the prescription is for ED.

Some plans may offer supplemental coverage for excluded drugs through enhanced coverage, but this is not required under basic Part D. If your prescription is for ED, check your plan documents or call the plan before assuming it is covered.

What if tadalafil is prescribed for BPH or pulmonary arterial hypertension?

Tadalafil may be covered under Part D when it is used for an FDA-approved medical condition other than sexual or erectile dysfunction. Examples may include:

Benign prostatic hyperplasia, or BPH: an enlarged prostate condition that can cause urinary symptoms.
Pulmonary arterial hypertension, or PAH: high blood pressure in the arteries of the lungs, treated with certain tadalafil products.

Even when the diagnosis is potentially coverable, your plan may still require prior authorization to confirm that the drug is being used for a covered condition.

Why might a Part D plan require prior authorization?

Prior authorization means the plan must approve coverage before it pays for the drug. Medicare.gov explains that plans may use prior authorization when they cover a drug for some medical conditions but not others.

For tadalafil, this can matter because the same active ingredient may be prescribed for both excluded and potentially covered uses. Your prescriber may need to provide diagnosis information or other documentation showing that the prescription is for a covered condition.

How can you check whether your tadalafil prescription is covered?

To check your coverage, review your drug plan’s formulary p or contact the plan directly. Ask about:

Whether tadalafil, Cialis, tadalafil PAH, Adcirca, or another related product is on the formulary.
Which tier the drug is on, since tiers affect your cost-sharing.
Whether prior authorization, step therapy, or quantity limits apply.
Whether the plan needs diagnosis information from your prescriber.

If the drug is not covered or a rule prevents coverage, you or your prescriber may be able to ask the plan for an exception. An exception is not guaranteed.

What is the key takeaway for tadalafil and Medicare Part D?

Tadalafil coverage is diagnosis-specific and plan-specific. Part D generally excludes tadalafil for erectile dysfunction, but may cover tadalafil for certain non-ED medical uses if the drug is on the plan’s formulary and plan requirements are met. The safest way to confirm coverage is to check the exact drug name, dosage, and diagnosis with your

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Official Sources

Erectile Dysfunction (ED) drugs
CMS guidance addressing whether erectile dysfunction drugs are covered under Medicare Part D.
Medicare Prescription Drug Benefit Manual, Chapter 6
CMS manual guidance on Part D drugs, excluded drugs, and ED drugs used for FDA-approved indications other than sexual or erectile dysfunction.
Drug plan rules | Medicare
Explains Medicare Part D plan rules such as prior authorization, step therapy, quantity limits, and exceptions.
What do drug plans cover? | Medicare
Explains that Part D plans use formularies and that each plan has its own list of covered prescription drugs.
CIALIS (tadalafil) tablets, for oral use - accessdata.fda.gov
FDA labeling showing tadalafil indications for erectile dysfunction and signs and symptoms of benign prostatic hyperplasia.
TADLIQ® (tadalafil) oral suspension - accessdata.fda.gov
FDA labeling for a tadalafil product used for pulmonary arterial hypertension.

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