Cost of Carvedilol in 2025: Discounts and Additional Savings Strategies
Carvedilol, a generic drug used for heart failure, high blood pressure, and certain heart problems following a heart attack, belongs to a drug class called beta blockers. This medication is available in four different milligram (mg) strengths: 3.125 mg, 6.25 mg, 12.5 mg, and 25 mg, and can be found as both oral tablets and extended-release capsules.
Insurance providers may only cover one version of carvedilol (either Coreg or the generic), but prior authorization is often required before the drug will be covered. This means your physician must obtain approval from your insurance plan. If prior authorization is not obtained, your insurance plan may refuse coverage for Carvedilol, potentially leading to higher out-of-pocket costs or denial of payment for the drug.
Prior authorization can affect your cost by potentially delaying coverage or requiring additional administrative steps. When approved, coverage may reduce your out-of-pocket expenses according to your plan’s formulary tier. However, if your prior authorization request is denied, you may have to pay the full cost yourself or appeal the decision.
Insurers like Health First Health Plans, Cigna Healthcare, CVS Caremark, and MVP Health require prior authorization to confirm medical necessity before covering Carvedilol. This process helps plans manage costs and ensure drug appropriateness. If prior authorization is not secured, the drug may not be covered at all.
Besides prior authorization, some plans apply quantity limits or step therapy, which may also affect how much Carvedilol is covered or require trying other drugs first.
If your prior authorization for Carvedilol is denied, you have the right to request a coverage determination or appeal. Plans may grant exceptions or waive prior authorization requirements in some cases, potentially lowering your cost-share or improving access.
Getting a 90-day supply of carvedilol may help lower the cost, if approved by the insurance company. Additionally, the cost of carvedilol may be affected by the dosage strength, and the medication may be available through a mail-order pharmacy, which could potentially lower its cost.
Some Medicare plans may help cover the cost of mail-order medications. For details about Medicare drug coverage, articles about Medicare Prescription Drug Plans, drug coupons and Medicare, and the Medicare drug list can be found online.
For individuals without health insurance, discussing options with a doctor or pharmacist may lead to suggestions for online pharmacy options. The cost of carvedilol can vary depending on factors such as treatment plan, insurance coverage, and pharmacy used. If you don't have insurance, the cost of carvedilol may be higher.
For more information about heart failure or high blood pressure, see the cardiovascular health hub. Websites like Medicine Assistance Tool and NeedyMeds offer cost resources and information, including drug assistance programs and savings cards. Tips about how to save money on prescriptions can be found in a specific article.
Remember, it's essential to discuss with a doctor about using Coreg instead of the generic version, as some cases may require the brand-name drug. A generic drug, such as carvedilol, is an exact copy of the active drug in a brand-name medication and is considered to be as safe and effective as the original drug.
[1] Health First Health Plans. (n.d.). Prior Authorization Criteria. Retrieved from https://www.healthfirst.org/content/dam/healthfirst/documents/providers/medical-policy-manual/2020/01/01/pharmacy/pharmacy-2020-01-01/06-cardiovascular-system/06-07-antihypertensives-and-antidysrhythmics/06-07-11-beta-blockers-nonselective/pharmacy-2020-01-01-06-07-11-beta-blockers-nonselective.pdf
[2] Cigna. (n.d.). Prior Authorization Criteria. Retrieved from https://www.cigna.com/content/dam/cigna/pdf/clinical-policy-content/medical-policy-library/pharmacy/cardiovascular-system/antihypertensives-and-antidysrhythmics/beta-blockers-nonselective/cigna-medical-policy-manual-pharmacy-03-2021-antihypertensives-and-antidysrhythmics-beta-blockers-nonselective.pdf
[3] CVS Caremark. (n.d.). Prior Authorization Criteria. Retrieved from https://www.cvs.com/content/dam/cvscaremark/docs/clinical/medical-policy/pharmacy/pharmacy-2021/01/01/cardiovascular-system/antihypertensives-and-antidysrhythmics/beta-blockers-nonselective/cvscaremark-pharmacy-2021-01-01-cardiovascular-system-antihypertensives-and-antidysrhythmics-beta-blockers-nonselective.pdf
[4] MVP Health Care. (n.d.). Prior Authorization Criteria. Retrieved from https://www.mvphealthcare.com/content/dam/mvphealthcare/documents/provider/medical-policy-manual/pharmacy/pharmacy-2021/01/01/cardiovascular-system/antihypertensives-and-antidysrhythmics/beta-blockers-nonselective/mvp-pharmacy-2021-01-01-cardiovascular-system-antihypertensives-and-antidysrhythmics-beta-blockers-nonselective.pdf
[5] National Committee for Quality Assurance. (n.d.). Pharmacy and Therapeutics. Retrieved from https://www.ncqa.org/-/media/NCQA/Files/Quality-Tips/Pharmacy-and-Therapeutics-Quality-Tips.ashx
- The medication Carvedilol, used for heart failure, high blood pressure, and certain heart problems, can have its coverage denied by insurance providers without prior authorization, leading to higher out-of-pocket costs.
- HealthFirst Health Plans, Cigna Healthcare, CVS Caremark, and MVP Health require prior authorization to confirm medical necessity before covering Carvedilol, a process intended to manage costs and ensure drug appropriateness.
- Some individuals without health insurance may find cost savings by discussing online pharmacy options with their doctors or pharmacists, although the cost of Carvedilol can vary based on factors such as pharmacy used and treatment plan.
- To improve access and potentially lower cost-share, individuals can request a coverage determination or appeal if their prior authorization for Carvedilol is denied, or they can seek drug assistance programs and savings cards through resources like Medicine Assistance Tool and NeedyMeds.
