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Generic Name	Brand Name	Strength	Dosing	90 Day Cost	Coverage	Comments	Category 1	Category 2
Nicotine Patch	Nicoderm	21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily)	21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily)	$280	BC - RST / IA - Covered	Lifetime $ limit	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nicotine Gum	Nicorette	2 mg	12 pcs/d	$375	BC - RST / IA - Covered	Lifetime $ limit	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nicotine Gum	Nicorette	4 mg	12 pcs/d	$375	BC - RST / IA - Covered	Lifetime $ limit	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nicotine Inhaler	Nicorette	Cartridges	6 ctgs/d	$465	BC - RST / IA - Covered	Lifetime $ limit	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nortriptyline	Aventyl	25 mg	3 HS	$170	BC / IA - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Varenicline	Champix	0.5 mg QD x 3 days, 0.5 mg BID x 4 days, 1 mg BID thereafter	0.5 mg QD x 3 days, 0.5 mg BID x 4 days, 1 mg BID thereafter	$190	BC - SA / IA Covered	Quantity limits	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Wellbutrin SR	150 mg	BID	$60	BC / IA - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Zyban	150 mg	BID	$215	BC / IA - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation

Legend:

BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection, SS=Social Services