Beta-Blockers, Oral
PDL Reference Documents
Drug Use Review Documents
Newsletters
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation |
|---|---|---|---|---|---|
| acebutolol HCl | ACEBUTOLOL HCL | CAPSULE | Y | ||
| atenolol | ATENOLOL | TABLET | Y | ||
| atenolol | TENORMIN | TABLET | Y | ||
| carvedilol | CARVEDILOL | TABLET | Y | ||
| carvedilol | COREG | TABLET | Y | ||
| labetalol HCl | LABETALOL HCL | TABLET | Y | ||
| metoprolol succinate | METOPROLOL SUCCINATE | TAB ER 24H | Y | ||
| metoprolol succinate | TOPROL XL | TAB ER 24H | Y | ||
| metoprolol tartrate | LOPRESSOR | TABLET | Y | ||
| metoprolol tartrate | METOPROLOL TARTRATE | TABLET | Y | ||
| nadolol | NADOLOL | TABLET | Y | ||
| nadolol | CORGARD | TABLET | Y | ||
| propranolol HCl | INDERAL LA | CAP SA 24H | Y | ||
| propranolol HCl | PROPRANOLOL HCL ER | CAP SA 24H | Y | ||
| propranolol HCl | PROPRANOLOL HCL | SOLUTION | Y | ||
| propranolol HCl | PROPRANOLOL HCL | TABLET | Y | ||
| betaxolol HCl | BETAXOLOL HCL | TABLET | N | ||
| bisoprolol fumarate | BISOPROLOL FUMARATE | TABLET | N | ||
| carvedilol phosphate | CARVEDILOL ER | CPMP 24HR | N | ||
| carvedilol phosphate | COREG CR | CPMP 24HR | N | ||
| metoprolol succinate | KAPSPARGO SPRINKLE | CAP SPR 24 | N | ||
| nebivolol HCl | NEBIVOLOL HCL | TABLET | N | ||
| nebivolol HCl | BYSTOLIC | TABLET | N | ||
| pindolol | PINDOLOL | TABLET | N | ||
| propranolol HCl | INDERAL XL | CAP ER 24H | N | ||
| propranolol HCl | INNOPRAN XL | CAP ER 24H | N | ||
| propranolol HCl | HEMANGEOL | SOLUTION | N | ||
| sotalol HCl | SOTYLIZE | SOLUTION | N | ||
| sotalol HCl | BETAPACE AF | TABLET | N | ||
| sotalol HCl | SOTALOL | TABLET | N | ||
| sotalol HCl | SORINE | TABLET | N | ||
| sotalol HCl | BETAPACE | TABLET | N | ||
| sotalol HCl | SOTALOL AF | TABLET | N | ||
| timolol maleate | TIMOLOL MALEATE | TABLET | N | ||
| timolol maleate | BLOCADREN | TABLET | N |