Limited Coverage Drugs – Bupropion

Generic Name

Strength 100 mg SR, 150 mg SR, 150 mg XL, 300 mg XL
Form tablet

Special Authority Criteria

Approval Period

Diagnosis indicating depression (GENERIC)



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; that is, 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 Request Form(s)

A Special Authority request must be submitted when generic bupropion is prescribed for depression by a physician other than a psychiatrist.