Medicare AdvantagePrior AuthMedium impact
Cialis® (tadalafil) (Revised)
Humana·Urology, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Cialis (tadalafil) prescriptions for benign prostatic hyperplasia (BPH), with specific criteria requiring previous treatment failure with alpha blockers and 5-alpha reductase inhibitors. This policy is effective January 1, 2026 and applies to both brand-name Cialis tablets and generic tadalafil tablets.
Action Required
By January 1, 2026: Billing team must update prior authorization processes for Cialis/tadalafil prescriptions for BPH patients on Humana Medicare Advantage plans. Providers must document diagnosis of BPH and previous treatment failure or contraindication to both alpha blockers (terazosin, doxazosin, tamsulosin, alfuzosin) AND 5-alpha reductase inhibitors (finasteride, dutasteride) before prescribing. Update EMR templates to include this documentation requirement. Claims without prior authorization will be denied.