Clickable Table

Generic Name	Brand Name	Strength	Dosing	90 Day Cost	Coverage	Comments	Category 1	Category 2
Nortriptyline	Aventyl	25 mg	3 HS	$205	BC / NIHB - Covered		D 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		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy Lifetime $ limit
Nicotine Inhaler	Nicorette	Cartridges	6 ctgs/d	$485	BC - Restricted / NIHB - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy Lifetime $ limit
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	D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Zyban	150 mg	BID	$240	BC / NIHB - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Wellbutrin SR	150 mg	BID	$195	BC / NIHB - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Nicotine Gum	Nicorette	2 mg, 4 mg	12 pcs/d	$390	BC - Restricted / NIHB - Covered		D Smoking Cessation Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy Lifetime $ limit

BC = Alberta Blue Cross, NIHB = Non-Insured Health Benefits for First Nations and Inuit, NC = Not covered, SA = special authorization