WELLBUTRIN
STEP
THERAPY
The step therapy program allows for payment of WELLBUTRIN if the MAHP plan participant has had trial with another antidepressant. The goal of the step therapy is prevent the use of WELLBUTRIN for smoking cessation given the equivalence to ZYBAN which has an FDA indication for smoking cessation. This step therapy is necessary due to many of MAHP plans not covering smoking cessation products as payable drugs within the Prescription Drug Benefit. WELLBUTRIN will not be covered for smoking cessation; requests for this will be directed to OTC products available.
When criteria are not met, the pharmacy will receive an electronic error message as they attempt to submit the participant’s prescription for payment via on-line computer transaction. The error message will direct the pharmacy that the medication requires a prior authorization. The pharmacy will then need to contact Health Care Services at MAHP. If additional clinical/medical information is needed related to the participant’s history with medications and diagnosis, the ordering practitioner will be contacted.
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Other SNRIs/antidepressants |
PA REQUIRED |
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MEDICATIONS |
amitriptyline hcl/perphenazine; ETRAFON 2-10 & 2-25; Generic TRIAVIL; trazodone (DESYREL); venlafaxine (EFFEXOR & EFFEXOR XR); mirtazapine (REMERON); nefazodone(SERZONE); clomipramine (ANAFRANIL); protriptyline (VIVACTIL); imipramine hcl (TOFRANIL); doxepin (SINEQUAN); nortriptyline (PAMELOR); amitriptyline (ELAVIL) Aventyl, CYMBALTA |
Bupropion (WELLBUTRIN) |
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CRITERIA FOR USE |
Driven by formulary status of drug and MAC policies. **Processing of brand name first-line drug will cause ancillary charges to participant |
Participants who have a diagnosis of depression and are not using for smoking cessation will be given a prior authorization. Participants who smoke and have a diagnosis of depression will be required to use a trial of another antidepressant first |
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