Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
carvedilol

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

Online Forms (PDF)
Click on the link to complete a special authority request form.