Clickable Table

Generic Name Brand Name Strength Dosing 90 Day Cost Coverage Comments Category 1 Category 2
Bupropion Zyban 150 mg BID $245 BC / NIHB - Covered Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Nicotine Gum Nicorette 2 mg, 4 mg 12 pcs/d $400 BC - Restricted / NIHB - Covered

Lifetime $ limit

Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
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

Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Bupropion Wellbutrin SR 150 mg BID $195 BC / NIHB - Covered Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Nicotine Patch Nicoderm 21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily) $280 BC - Restricted/ NIHB - Covered

Lifetime $ limit

Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
Nortriptyline Aventyl 25 mg 3 HS $210 BC / NIHB - Covered Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Nicotine Inhaler Nicorette Cartridges 6 ctgs/d $500 BC - Restricted / NIHB - Covered

Lifetime $ limit

Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
Legend:
BC = Alberta Blue Cross, NIHB = Non-Insured Health Benefits for First Nations and Inuit, NC = Not covered, SA = special authorization