Limited Coverage Drugs – Carvedilol

Generic Name

carvedilol
Strength 3.125 mg, 6.25 mg, 12.5 mg, 25 mg
Form tablet

Special Authority Criteria

Approval Period

For treatment of stable symptomatic congestive heart failure


PLUS


Concurrent therapy with an Angiotensin Converting Enzyme Inhibitor (ACE-I)

Indefinite

 

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • None

Special Authority Request Form(s)