ADCIRCA Understanding Insurance

Government Payer

Children’s Health Insurance Program (CHIP) provides coverage to eligible children whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. It is best to check state guidelines to ensure eligibility.

Visit www.medicaid.gov/chip/index.html for more information.

Department of Defense TRICARE is the healthcare program available for active-duty members of our armed services and their family members, retirees, and retiree family members.

Visit www.tricare.mil/Plans for more information.

Indian Health Services (IHS) provides health services to American Indians and Alaska Natives who belong to federally recognized tribes within the United States.

Visit www.ihs.gov for more information.

Medicaid provides health coverage for eligible low-income individuals and is administered by states, according to federal requirements.

Visit www.medicaid.gov for more information.

Medicare is a government-funded insurance that provides healthcare coverage to individuals 65 years of age or older. People under 65 years of age may be eligible due to certain disabilities. Open enrollment for Medicare is from October 15 through December 7 each year. During this period, you can choose Original Medicare or add Medigap and choose or change a Part C or Part D plan.

There are four parts of Medicare:

Medicare Part A is used for inpatient hospital stays, skilled nursing facility stays, hospice care, and home health care
Medicare Part B is used for outpatient care and medical coverage including, but not limited to, doctor visits, lab tests, diagnostic services, and durable medical equipment
Medicare Part C is private health insurance that is an alternative to Original Medicare
Medicare Part D is the prescription drug plan for Medicare recipients
- Extra Help, or Low-Income Subsidy, is a program to help limited income individuals pay for prescription drug and program costs
- Limited Income NET (LINET) program provides temporary prescription drug coverage for low-income Medicare beneficiaries who have not yet enrolled in a Medicare Part D plan
Medigap is private healthcare coverage offered by insurance companies to supplement Original Medicare.

Visit www.cms.gov for more information.

Veterans’ Health Administration (VA) provides health coverage to American veterans.

Visit www.va.gov/health for more information.

What is commercial or private insurance?

Commercial or private insurance plans may be purchased directly from an insurance carrier, insurance broker, Healthcare.gov, or through an employer group. Once a year, during the designated open enrollment period, you may enroll in commercial or private insurance. You may be eligible for special enrollment if you have experienced a qualifying life event, examples include: recently becoming a citizen, moving to a new area, marriage, divorce, birth or adoption of a child, or losing your insurance coverage.

Visit www.healthcare.gov for more information.

How do I know what my coverage is?

Contact ASSIST via phone at 877-864-8437, via email by selecting the email option, or complete the Patient Authorization Form and forward to ASSIST. An ASSIST Specialist will be in contact to help navigate topics such as insurance coverage, prior authorization requirements, and in-network pharmacies.

Indication

ADCIRCA (tadalafil) is a prescription medication used to treat pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise ability. Studies establishing effectiveness included predominately patients with NYHA Functional Class II–III symptoms and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (23%).

Important Safety Considerations for ADCIRCA (tadalafil)

You should discuss all of your medical conditions and all medications with your healthcare provider before starting ADCIRCA

Do not take ADCIRCA if you take any medications that contain nitrates (often used for chest pain) or guanylate cyclase stimulators, as the combination could cause a sudden, unsafe drop in blood pressure

Do not take ADCIRCA if you are allergic to tadalafil or any other ingredient in ADCIRCA

ADCIRCA is a type of medication called a phosphodiesterase 5 inhibitor (PDE-5i) that can cause blood vessels to widen, which may result in a decrease in blood pressure. If you have heart-disease or any problems with low blood pressure, tell your healthcare provider before taking ADCIRCA, as these conditions may be affected by the action of ADCIRCA

Talk with your healthcare provider if you are pregnant or planning to become pregnant or if you are breastfeeding or plan to breast feed.

If you have ever had blockage in the veins of your lungs, known as pulmonary veno-occlusive disease (PVOD), ADCIRCA is not recommended for you

Taking ADCIRCA with alcohol, or blood pressure medications, such as alpha-blockers, may lower blood pressure and cause hypotension (light-headedness or fainting)

Do not take ADCIRCA if you are taking rifampin (an antibiotic for certain bacterial infections), or antifungal medications, such as ketoconazole and itraconazole. If you require treatment with both ADCIRCA and ritonavir (Norvir®) at the same time, your dose of ADCIRCA will need to be adjusted. Inform your healthcare provider if you have kidney or liver problems before taking ADCIRCA

ADCIRCA contains the same ingredient (tadalafil) as Cialis®, which is used to treat erectile dysfunction (ED, impotence) and the signs and symptoms of benign prostatic hyperplasia (BPH, enlarged prostate). If you are taking ADCIRCA, do not take Cialis or other PDE-5is

In rare cases, patients reported side effects such as decreased eyesight or loss of vision in one or both eyes (NAION), or sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness. If you experience any of these side effects after taking ADCIRCA, seek medical attention right away

In rare cases, men taking PDE-5is (including tadalafil) for erectile dysfunction reported side effects such as an erection lasting more than four hours. If you experience a prolonged erection, seek medical attention right away

The most common side effects of ADCIRCA are headache, muscle pain, getting red or hot in the face (flushing), nausea, pain in the arms, legs or back, upset stomach, stuffy or congested nose

ADC.ISI.CON.SEP2020

Understanding Insurance Types

Government Payer

Children’s Health Insurance Program (CHIP)

Department of Defense TRICARE

Indian Health Services

Medicaid

Medicare

Veterans’ Health Administration

What is commercial or private insurance?

How do I know what my coverage is?

Indication

Important Safety Considerations for ADCIRCA (tadalafil)