Product Details
Act Bupropion XL
Bupropion HCl150 mg
ER Tablet
DIN/PIN/NPN
02439654
Manufacturer
Actavis Pharma Company
Formulary Listing Date
2016-07-28
Unit Price
0.2926
Amount MOH Pays
0.2926
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 |
|---|---|---|---|
| 02275090 | Wellbutrin XL | 0.5916 | 0.2926 |
| 02475804 | Taro-Bupropion XL | 0.2926 | 0.2926 |
| 02439654 | Act Bupropion XL | 0.2926 | 0.2926 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 315 | Indefinite | For the treatment of depression. |