Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
---|---|---|---|---|---|---|---|---|
Dutasteride | Avodart | 0.5 mg | QD | $45 | BC - Covered / IA - Covered | J Urology | Benign Prostatic Hyperplasia (BPH) | |
Tamsulosin CR | Flomax CR | 0.4 mg | QD | $30 | BC / IA - Covered | J Urology | Benign Prostatic Hyperplasia (BPH) | |
Terazosin | Hytrin | 2 mg | QD | $35 | BC / IA - Covered | J Urology | Benign Prostatic Hyperplasia (BPH) | |
Finasteride | Proscar | 5 mg | QD | $55 | BC / IA - Covered | J Urology | Benign Prostatic Hyperplasia (BPH) | |
Tadalafil | Cialis | 20 mg | As dir | $70 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
J Urology | Erectile Dysfunction |
Vardenafil | Levitra | 20 mg | As dir | $70 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
J Urology | Erectile Dysfunction |
Sildenafil | Viagra | 50 mg, 100 mg | As dir | $55 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
J Urology | Erectile Dysfunction |
Testosterone Undecanoate | Andriol | 40 mg | BID | $105 | BC - SA / IA - Covered | J Urology | Testosterone Replacement | |
Testosterone Patch | Androderm | 5 mg/day | QD | $455 | BC / IA - SA | J Urology | Testosterone Replacement | |
Testosterone Gel | Androgel | 5 g | QD | $445 | BC - NC / IA - SA | J Urology | Testosterone Replacement | |
Testosterone Enanthate | Delatestryl | 200 mg/mL | 400mg Q30D | $85 | BC / IA - Covered | J Urology | Testosterone Replacement | |
Testosterone Cypionate | Depo-Testosterone | 100 mg/mL | 200mg Q2W | $75 | BC / IA - Covered | J Urology | Testosterone Replacement |