Product Details
Act Bupropion XL
Bupropion HCl300 mg
ER Tablet
DIN/PIN/NPN
02439662
Manufacturer
Actavis Pharma Company
Formulary Listing Date
2016-07-28
Unit Price
0.5853
Amount MOH Pays
0.5853
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N06AX12
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02275104 | Wellbutrin XL | 1.1833 | 0.5853 |
02475812 | Taro-Bupropion XL | 0.5853 | 0.5853 |
02439662 | Act Bupropion XL | 0.5853 | 0.5853 |
LU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
315 | Indefinite | For the treatment of depression. |