Sotalol is the clearest example in American pharmacy of a cheap drug attached to an expensive process. The tablets cost about fourteen cents a day. Getting them started, under the terms of the drug’s own FDA label, usually means three nights in a hospital bed wired to a monitor.
If you are uninsured and a cardiologist has just proposed sotalol for atrial fibrillation or a ventricular arrhythmia, the pill price is not the number you need. This page prices the therapy: the admission, the monitoring inside it, the physician fees layered on top, and then the trivially cheap prescription you go home with. Every figure was researched on September 4, 2026.
What Does Sotalol Cost Without Insurance?
Drug acquisition costs come from the CMS National Average Drug Acquisition Cost survey, effective August 19, 2026. Retail cash prices come from Drugs.com and Cost Plus Drugs, read September 4, 2026. Hospital figures are 2024 Medicare claims released by CMS in April 2026, one hospital’s own published cash price from a file updated March 31, 2026, and KFF’s compilation of the 2024 American Hospital Association survey. Physician fee figures are 2024 national averages released by CMS on May 21, 2026.
| Item | Low | Typical | High |
|---|---|---|---|
| Sotalol 80 mg, 30 tablets | $2.09 (acquisition cost) | $6.10 (Cost Plus) | $12.07 (Drugs.com) |
| Sotalol 80 mg, one month (80 mg twice daily, 60 tablets) | $4.17 | $9.62 | $12.84 |
| Sotalol 80 mg, one year (720 tablets) | $50.05 | $115.46 | $154.08 |
| Brand Betapace 80 mg, one month | $1,495.41 | $1,495.41 | $1,495.41 |
| Brand Betapace AF 80 mg, one month | $637.87 | $637.87 | $923.23 |
| Loading admission, MS-DRG 310 | $5,418.56 (negotiated) | $9,892 (3 days at hospital cost) | $28,728.33 (average billed) |
| Loading admission, posted cash price | $27,496.16 | $27,496.16 | $27,496.16 |
| Physician fees across a 3-day admission | $397.37 (allowed) | $397.37 | $1,197.53 (submitted) |
| ECG with interpretation (CPT 93000), each | $14.20 (allowed) | $69.03 (submitted) | $122.94 (hospital cash) |
| Basic metabolic panel (CPT 80048), each | $8.27 (allowed) | $47.97 (submitted) | $47.97 |
| Ongoing monitoring, one year | $301.34 (allowed) | $565.94 | $830.54 (submitted) |
| First year of sotalol therapy | $6,167 | $10,971 | $30,910 |
The first-year row is the point of this page. The drug contributes $50 to $154 of it. Everything else is the admission and the surveillance the label attaches to it.
The ongoing-monitoring row assumes two follow-up office visits (CPT 99214), two ECGs, two basic metabolic panels and two blood draws in a year. At Medicare-allowed rates that bundle is $301.34; at average submitted charges it is $830.54. The typical column is the midpoint, which is roughly where a negotiated self-pay rate tends to land.
Why the Admission Exists, and What It Costs
Sotalol carries a boxed warning for life-threatening proarrhythmia. The prescribing information for Betapace and Betapace AF, updated December 16, 2024, is unusually specific: hospitalize patients being initiated or re-initiated on sotalol for at least 3 days, or until steady-state drug levels are achieved, in a facility that can provide cardiac resuscitation and continuous electrocardiographic monitoring. The label also directs prescribers to obtain a baseline ECG, normalize serum potassium and magnesium, measure serum creatinine to calculate a dosing interval, and check the QTc 2 to 4 hours after each dose increase, with increases no more often than every 3 days.
That maps to a real hospital stay, and the closest billing analogue is MS-DRG 310, cardiac arrhythmia and conduction disorders without complications. CMS 2024 Medicare claims put the national average submitted covered charge for that DRG at $28,728.33 across 31,241 discharges, against an average total payment of $5,626.98 and an average Medicare payment of $3,544.63. With complications the numbers climb: DRG 309 averages $36,114.59 billed and $7,304.49 paid, and DRG 308 averages $56,635.46 billed and $11,418.71 paid.
One hospital’s own published prices land within five percent of the federal charge figure and confirm the shape of the gap. Novant Health Presbyterian Medical Center’s machine-readable standard charges file lists an estimated discounted cash price of $27,496.16 for MS-DRG 310, with negotiated payer rates on the same row running from $5,418.56 to $11,435.79. The posted cash price is more than twice the highest negotiated rate and five times the lowest. That is the entire negotiating space for a self-pay patient, and it is unusually well documented here.
For a third angle, KFF’s compilation of the 2024 AHA Annual Survey puts hospital expenses at $3,297.26 per adjusted inpatient day nationally, ranging from $1,400.53 in Mississippi to $4,744.25 in California. Three days of that is about $9,892, and roughly $4,200 to $14,200 depending on the state. Our hospital stay cost per day guide breaks that figure apart.
What Drives the Price
Inpatient versus observation status. Whether your three nights are billed as an inpatient admission or as outpatient observation changes the payment system, the line items and the discounts you can ask for. Ask each day which one you are, and get the answer in writing.
Physician fees are billed separately from the hospital. A typical three-day admission generates an initial hospital care code (CPT 99223, averaging $568.32 submitted against $167.52 allowed), two subsequent care days (CPT 99232 at $203.42 submitted and $76.05 allowed each), and a discharge day (CPT 99238 at $222.37 submitted and $77.75 allowed). That is $1,197.53 submitted and $397.37 allowed on top of the facility bill, from separate providers who send separate statements.
How many ECGs get run. The label calls for a QTc check 2 to 4 hours after each dose increase, and increases happen every 3 days, so a straightforward load generates a baseline plus several tracings. CMS prices a routine ECG with interpretation (CPT 93000) at an average submitted charge of $69.03 against $14.20 allowed in an office setting. The hospital price is higher: Community Hospital of Stokes lists a 12-lead EKG at a $180.80 gross charge and a $122.94 discounted cash price in the file it updated June 24, 2026, with the professional interpretation billed separately at $38.42 cash. Our EKG cost guide covers what one costs outside a hospital.
The electrolyte and kidney labs. Potassium, magnesium and creatinine are all named in the label. CMS national averages put potassium (CPT 84132) at $22.03 submitted and $4.63 allowed, magnesium (CPT 83735) at $38.22 and $6.55, creatinine (CPT 82565) at $22.73 and $4.89, and the basic metabolic panel that bundles most of them (CPT 80048) at $47.97 and $8.27. Ordering the panel instead of the components is the cheaper path for the same information. See our blood work cost guide for self-pay lab pricing.
Which sotalol, and which brand. Generic sotalol is $0.06951 per 80 mg tablet, $0.11063 at 120 mg, $0.13511 at 160 mg and $0.18766 at 240 mg in CMS data. Brand Betapace is $24.92 per 80 mg tablet on Drugs.com, roughly 360 times the generic acquisition cost, and Betapace AF runs $637.87 to $923.23 for 60 of the 80 mg. Sotylize, the branded oral solution, is $2.32452 per mL, so a 120 mg liquid dose is about $55.79. Intravenous sotalol is a separate world again: Drugs.com prices the 15 mg/mL intravenous solution at $3,352.68 for 10 mL.
Sotalol AF is a different labeled product. Betapace (NDA 019865) and Betapace AF (NDA 021151) are separate FDA applications with separate labels, separate imprints and separate indications, even though the molecule is identical. CMS prices the generics identically per strength, but retail does not always follow: Cost Plus Drugs charges $11.00 for 30 of the generic sotalol AF 160 mg against $6.86 for 30 of the plain sotalol 160 mg. If your prescription does not have to say AF, the plain version can be cheaper.
Cash Price vs. Insurance
On the tablets, cash almost always wins. A $6.10 mail-order fill or a $12 to $14 retail fill sits below most copays, and the transaction stays off your benefit.
On the admission, the calculus reverses completely. The gap between the $27,496 posted cash price and the $5,419 to $11,436 negotiated range at the same hospital is the single largest dollar figure on this page, and you cannot close it by asking politely at discharge. If you have any coverage at all, use it for the hospital stay even if you pay cash for the pills.
If you are fully self-pay, the leverage is in acting before the stay, not after. Hospitals publish these prices in machine-readable files, and our guide to hospital price transparency explains how to pull one and find your DRG before you are admitted. Every nonprofit hospital also runs a financial assistance program; our hospital charity care guide covers who qualifies and how to apply, and the charity care check tool will tell you whether your income clears a given hospital’s threshold.
One thing worth stating plainly: the three-day monitored start is not an upsell. It sits in the boxed warning because sotalol can trigger a fatal arrhythmia during dose escalation. This page is about what that admission costs and how to pay less for it, not about whether to have it.
How to Pay Less
-
Apply for charity care before the admission, not after. An elective sotalol load is scheduled, which means you have time. Ask the hospital’s financial counselor for the financial assistance application and the discounted cash price for MS-DRG 310 in writing before you check in. Our hospital charity care guide walks through the paperwork.
-
Get the all-in quote in advance and ask what is not in it. Physician fees ($397 to $1,198 across the stay), ECGs and labs are frequently billed by separate entities. Ask specifically which of them are inside the quoted price. Run the number you are given through the fair price checker.
-
Negotiate against the negotiated rate, not the charge. At Novant Presbyterian, commercial and government payers pay $5,418.56 to $11,435.79 for the DRG that carries a $27,496.16 posted cash price. Naming that spread is far more effective than asking for a generic discount. Our guide to negotiating medical bills has the scripts, and the negotiation script tool will draft one for a specific bill.
-
Demand an itemized bill and check the ECG count. Tracings, interpretations and telemetry hours are all separately coded, and duplicate or unperformed lines are common. Our guide to reading an itemized hospital bill explains what to look for.
-
Fill the maintenance prescription at a transparent pharmacy. Cost Plus Drugs lists sotalol 80 mg at $6.10 for 30, 120 mg at $6.35, 160 mg at $6.86 and 240 mg at $8.17, all with a flat $5.00 shipping charge. Drugs.com shows the retail curve falling with quantity, from $12.07 for 30 of the 80 mg to $80.18 for 500. Check a discount card too; our comparison of GoodRx vs. SingleCare explains how.
-
Never accept the brand. Betapace at $24.92 a tablet against $0.07 for the generic is the widest brand premium on the cardiac shelf. If a pharmacy quotes you a brand price, ask for the generic by name.
Bottom Line
Sotalol costs about $50 to $154 a year as a drug and roughly $6,200 to $30,900 in its first year as a therapy. The pills are a rounding error inside a hospital bill.
Treat the admission as the purchase. Get the DRG cash price in writing, apply for charity care before you are admitted, ask which physician groups will bill separately, and then fill the maintenance prescription for six dollars a month. If your cardiologist is weighing other rhythm drugs, our amiodarone and flecainide cost guides tell similar stories about cheap molecules with expensive requirements, and our propranolol and diltiazem guides cover the plain beta blocker and rate-control alternatives, neither of which needs an inpatient start.