Limited coverage criteria – carvedilol

Last updated on March 17, 2025

Special Authority requests can now be submitted online. It's simple and quick!

This drug is eligible for automatic approval when patient meets criteria and the request is submitted by eForms.

Generic name	carvedilol
Strength & form	3.125 mg, 6.25 mg, 12.5 mg, 25 mg 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

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

None

Special notes

None

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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