Eligible Smoking Cessation Products
Nicotine replacement therapy products
| Brand Name | Product Type | Strength | Pack Size | Natural Product Number (NPN) | Temporary NPN |
|---|---|---|---|---|---|
| Nicorette® | gum1 | 2 mg | 105 | 80069513 | |
| Nicorette® | gum1 | 4 mg | 105 | 80069471 | |
| Nicorette® | lozenge2 | 2 mg | 80 | 2247347 | |
| Nicorette® | lozenge2 | 4 mg | 80 | 2247348 | 80053100 |
| Nicoderm® Step 1 | patch | 21 mg | 7 | 80044515 | |
| Nicoderm® Step 2 | patch | 14 mg | 7 | 80044503 | |
| Nicoderm® Step 3 | patch | 7 mg | 7 | 80044518 |
1 Nicorette gum flavour: Ultra Fresh Mint only.
2 Nicorette lozenge flavour: Mint only.
Smoking cessation prescription drugs
| Generic Name | Brand Name | Dosage Type | Strength | DIN |
|---|---|---|---|---|
| bupropion3 | Zyban® | tablet ER | 150 mg | 2238441 |
| varenicline | Champix®4 | tablet | 0.5 mg | 2291177 |
| varenicline | Champix®4 | tablet | 1 mg | 2291185 |
| varenicline | Champix®4 | tablet DS PK | 0.5 mg and 1 mg | 2298309 |
| varenicline | Apo-Varenicline | tablet | 0.5 mg | 2419882 |
| varenicline | Apo-Varenicline | tablet | 1 mg | 2419890 |
| varenicline | Apo-Varenicline | tablet DS PK | 0.5 mg and 1 mg | 2435675 |
| varenicline | Teva-Varenicline | tablet DS PK | 0.5 mg and 1 mg | 2426781 |
3 PharmaCare covers only the Zyban® brand of bupropion. Wellbutrin®, Wellbutrin XL®, and generic bupropion are not covered as smoking cessation prescription drugs.
4 PharmaCare fully covers generic versions of varenicline (i.e., Apo-Varenicline, Teva-Varenicline). The brand name Champix® is only covered as a partial benefit.
Physicians: To ensure that PharmaNet correctly adjudicates smoking cessation claims for Zyban®, please use the brand name, include the indication, and note "no substitutions" in the written prescription.
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