So leading on from above I ended up down something of an NHS rabbit hole. What a shambles

This will likely only be of interest to those members who are prescribed ED meds by their GP.
I last reported on this in 2024.
https://www.ukpunting.com/index.php?topic=431025.msg4279075#msg4279075Historically branded ED meds Viagra, Cialis etc were only available on NHS prescription for those who met the Selected List Scheme (SLS) criteria and which is shown below.
All options have been available on private prescription if medically/clinically justified and on the basis that there is no charge for issuing the prescription just the cost of the medication and dispensing it.
Once the Viagra patent expired and generics became available, then generic sildenafil eventually could be prescribed for everyone on NHS prescription and not just those eligible under SLS criteria, but with quantity restrictions.
Generic Tadalafil when it became available, was vastly cheaper than Cialis, but was still only available on NHS prescription under SLS.
Somewhere along the line it was decided that daily tadalafil 5mg for ED showed no benefit over ‘on demand’ dosing and it was recommended it no longer be available at all on the NHS even under SLS (
in most regions) and it was removed.
However, in 2023 this was reversed again and by 2024 most ICGs had updated their Formularies to include Tadalafil daily but only to those eligible under SLS.
Not only was it back in vogue, but some ICB recommendations are advising its use over ‘on demand’ tadalafil.
So fast forward and I have learned today that the SLS requirement for both generic Tadalfil and Vardenafil was removed nine months ago in October 2025.
External Link/Members OnlyThis means that they are available to everyone on NHS prescription and not just SLS patients, though quantity may be restricted.
There are now also way more local variations in first line treatment. Most still have Sildenafil as first choice progressing to Tadalafil (either on demand or daily) but one had Tadalfil as first choice?
The only consistency seems to be that 2.5mg Tadalafil tablets should not be prescribed on NHS prescriptions due to their cost compared to 5mg. Splitting however is not advised.
If you want to find out your local prescribing guidelines, first find your relevant ICB here
External Link/Members OnlyFrom there you need to search for the current Formulary linked to that ICB. This is not always straight forward as it seems some ICB’s have sub division formularies.
This is my local ICB Formulary
External Link/Members OnlyIt also links to this flow diagram protocol (others may not)
External Link/Members OnlyNow this is actually bang up to date with the changes in 2024 and October 2025, but when looking at a random selection of other ICB's some were equally up to date but others were not.
When searching, do not rely on AI summaries as they are mostly incorrect and out of date. Largely because the sources they are using are also either conflicting or out of date. Good luck.
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