- As an aid to smoking cessation treatment
Coverage of drugs is first determined by the member’s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document.
CHANTIXTM (varenicline)
NATL
Drug | Dosing Regimen | Dose Limit/ Maximum Dose |
---|---|---|
NicotrolR NS* (nicotine nasal spray) | Initial Treatment (Up to 12 weeks): 2 - 4 sprays intranasally per hour; minimum effective dose is 16 sprays per day. Reduction: Dose may be reduced as nicotine withdrawal subsides. | 40 mg/day (80 sprays) |
NicotrolR Inhaler* (nicotine inhaler) | Initial Treatment (Up to 12 weeks): At least 6 cartridges via oral inhalation daily for 3-6 weeks. Additional cartridges may be used if needed, up to 16 cartridges per day Reduction (Up to 12 weeks): Patients should be encouraged to gradually reduce the number of cartridges used | 16 cartridges/day |
(bupropion hydrochloride sustained release) ZybanR* | 150 mg PO daily for first 3 days then increase to 150 mg PO BID | 300 mg/day |
Drug | Dosing Regimen | Authorization Limit |
---|---|---|
ChantixR (varenicline) | Titration schedule: | 12 week course per calendar year HNOR Initial: 12 weeks Continuation: 12 weeks if the member is abstinent upon completing initial 12 weeks |