Limited coverage drugs – bupropion
Last updated on January 22, 2024
|
Generic name |
bupropion |
|---|---|
| Strength | 100 mg SR, 150 mg SR, 150 mg XL, 300 mg XL |
| Form | tablet |
|
Special Authority criteria |
Approval period |
|---|---|
| Diagnosis indicating depression (generic) |
Indefinite |
| Smoking cessation (Zyban® only) for patients who want to stop smoking or using other tobacco products. | 12 weeks within a calendar year—no Special Authority required |
Practitioner exemptions
- Bupropion (generic): Psychiatrists, when prescribed for depression only.
- Zyban® only: No Special Authority required when prescribed under the Smoking Cessation Program. See details below.
Special notes
Generic bupropion for depression
- Criteria applicable for all plans, including Plan G.
- Generic bupropion is eligible for PharmaCare coverage only when prescribed for depression; coverage is not available when it is prescribed for any other indication.
Zyban® for smoking cessation
- For smoking cessation, PharmaCare covers only the Zyban brand; Wellbutrin®, Wellbutrin XL® and generic bupropion are not covered for this indication.
- When prescribing Zyban under the Smoking Cessation Program, no Special Authority request is required.
- Maximum amount covered per calendar year: one 12-week (84-day) course of bupropion (Zyban) or varenicline.
- Written prescription must indicate:
- the brand name "Zyban"
- "smoking cessation"
- "no substitutions"
- "dispense in 28-day supply"
Special Authority requests
A Special Authority request must be submitted when generic bupropion is prescribed for depression by a physician other than a psychiatrist.