Microsoft word - guideline_4574.doc
Prior Authorization Guideline Guideline: CSD - Impotence Agents Therapeutic Class: Cardiovascular Agents Therapeutic Sub-Class: Vasodilating Agent Client: County of San Diego Approval Date: 2/13/1998 Revision Date: 12/6/2005 I. BENEFIT COVERAGE Table 1: Formulary status Non-Formulary Products Formulary Products Levitra® (vardenafil) Muse® (alpro