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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) $280 BC - Restricted/ NIHB - Covered

Lifetime $ limit

 Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
Nicotine Gum Nicorette 2 mg 12 pcs/d $380 BC - Restricted / NIHB - Covered

Lifetime $ limit

 Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
Nicotine Gum Nicorette 4 mg 12 pcs/d $380 BC - Restricted / NIHB - Covered

Lifetime $ limit

 Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Nicotine Replacement Therapy
Nicotine Inhaler Nicorette Cartridges 6 ctgs/d $470 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 $185 BC / NIHB - Covered 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 $190 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 $120 BC / NIHB - Covered Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Bupropion Zyban 150 mg BID $225 BC / NIHB - Covered Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
Smoking Cessation
Legend:
BC = Alberta Blue Cross, NIHB = Non-Insured Health Benefits for First Nations and Inuit, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection, SS=Social Services