Product Details

Act Bupropion XL

Bupropion HCl
300 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.

 

EAP Criteria

NO

Product Monograph

View Monograph