Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| Varenicline | Champix | 0.5 mg QD x 3 days, 0.5 mg BID x 4 days, 1 mg BID thereafter | $100 | BC - Restricted / NIHB - Covered |
Quantity limits |
P
&K000000Smoking Cessation &"System Font,Regular"
&K000000Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
| Nortriptyline | Aventyl | 25 mg | 3 HS | $210 | BC / NIHB - Covered |
P
&K000000Smoking Cessation &"System Font,Regular"
&K000000Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
| Bupropion | Wellbutrin SR | 150 mg | BID | $195 | BC / NIHB - Covered |
P
&K000000Smoking Cessation &"System Font,Regular"
&K000000Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
| Bupropion | Zyban | 150 mg | BID | $245 | BC / NIHB - Covered |
P
&K000000Smoking Cessation &"System Font,Regular"
&K000000Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation |