| NAME |
TADALAFIL (EQV-ADCIRCA) 20MG TAB |
| VA GENERIC NAME |
TADALAFIL |
| DOSAGE FORM |
TAB |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Restricted to patients that have an inadequate or lack of response to an appropriate trial of sildenafil
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
20 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
TADALAFIL TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2018-08-24 00:00:00
- COPAY END DATE: 2021-12-31 00:00:00
-
- COPAY TIER LEVEL: 1
- COPAY EFFECTIVE DATE: 2022-01-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TADALAFIL (EQV-ADCIRCA) 20MG TAB |
| VA PRODUCT IDENTIFIER |
T0990 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037765 |
| EFFECTIVE DATE/TIME |
-
- 2018-08-24 00:00:00
- STATUS: ACTIVE
|
