My wife received a prescription for Zyban, which our health insurance doesn’t cover. I asked about Wellbutrin, instead, which they DO cover, but which is not PREFERRED (i.e., it will cost us more). I asked what the preferred equivalent or generic was, and the operator told me, “bupropion–that’s not a generic.”
Now, everything I’ve been able to find indicates that bupropion is, in fact, the generic name for Zyban/Wellbutrin (bupropion HCl).
Is she wrong, or am I?
She is.
Bupropion is the generic name for Zyban and Wellbutrin, although they are in different doses. Bupropion can cause seizures depending on dose (in fact, Zyban and Wellbutrin are contraindicated), so you’ll need to watch carefully.
May want to wait for Qadgop to show up and offer his advice on substitution. IANAD, but I am a drug-discovery scientist. I can tell you all you need to know about the biochemistry behind them, but I’ll defer to the experts when it comes to prescribing.
Bupropion is Zyban is Wellbutrin. Wellbutrin SR 150 twice a day is effectively the same as Zyban 150 (sustained release) twice a day. I won’t speculate on why they label the same product differently for different purposes. I have seen a generic Bupropion being sold out there in the states. But probably not a generic of the 150mg sustained release tablets. It’s in the 100mg rapid release form.
Theoretically, taking 100 mg of the rapid release bupropion 3 times a day should be about as effective as taking the Zyban 150 twice a day, but I don’t know if this dosing and approach is actually supported in the literature.
here’s a possibly helpful link
I suspect she may have been inaccurate in her language, rather than her message.
While buproprion is the generic name for the drug, it may or may not be currently available in generic form. Depends on when the patents run out. If BigDrugCorp (no idea which one) still holds patent rights, then no one can market a cheap generic version. I don’t know the scoop on this particular drug, but I’m taking some $1+/dose meds myself - not available generic. My doc & pharmacy customarily give me generic if possible and IIRC I had to get Wellbutrin when I tried it about a year ago.
OTOH, I’d certainly ask again - health insurance phone clerks often don’t get the answers right IME.
I would imagine it’s that antidepressants have something of a negative connotation. Kind of like, "She’s not on Prozac for her PMS, she’s on “Sarafem”.
Marketing. There are those that will take a pill that is a smoking deterrent but not an anti-depressant *(I’m not crazy!) * Also, patent protection. Since Zyban is newer than Wellbutrin, and approved with a different indication/use, this extends their patent protection as Zyban but not Wellbutrin.
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** I have seen a generic Bupropion being sold out there in the states. But probably not a generic of the 150mg sustained release tablets. It’s in the 100mg rapid release form. Theoretically, taking 100 mg of the rapid release bupropion 3 times a day should be about as effective as taking the Zyban 150 twice a day, but I don’t know if this dosing and approach is actually supported in the literature.**
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The generic bupropion is available in 75mg and 100mg immediate-release tablets as generics of the original strengths of Wellbutrin. Wellbutrin SR (sustained release) was itself available later so the generics will follow the SR strengths when the patent goes on them. Since Wellbutrin SR is available in 150mg, a generic version in 150mg will come, but it won’t be “for Zyban” until the patent runs out on Zyban itself. Most states mandate following the Federal “Orange Book” standards on generics, which would preclude using a generic Wellbutrin SR 150 as a generic for Zyban. Your state’s laws may differ. Ask your pharmacist if s/he has to follow Orange Book.
In sum, I fill scripts every day for both Wellbutrin SR 150 and generic buproprion 100 that are intended for use as smoking cessation aids. The real problem is getting the insurance companies to cover bupropion in any form. They know what Zyban is and most won’t pay for it. Therefore, they may put you through extra trouble to pay for any bupropion product, or not pay for it at all. I would say that only around 10% of Zyban and only 40% of the bupropion I dispense is being covered by insurance.
Christopher Reves, D.Ph.
Ole Miss '95
Play Dixie! Play Dixie!
So, Chris, just to sum up–if we can get the doctor to give us a new prescription (she knew it might be a problem and said she could re-write the scrip if we needed a diff. variant) for Bupropion HCl (which our insurance covers), the effects of taking generic Bupropion would be the same as taking Zyban?
In my opinion, yes.
Remember one very important point - the pill itself is not going to make you quit smoking. You have to want to quit. All the pills, patches, and filters in the world won’t help you walk past the checkout without stopping for another pack or carton.
I wish you every success. I quit smoking myself almost 6 years ago now. It really does make a difference in your life.
Glad I could help. It’s a pleasure to help someone with an insurance problem this way rather than being yelled at by someone who thinks that “the insurance is supposed to cover everything”.
Can I get an amen, brother? Sometimes I wish that more people could empathize with the poor RPh who through no fault of his own has to hold up the dispensing of everyone’s prescriptions because of silly technical insurance stuff. I have had the same problem over and over again with Sarafem (which is just another labeling for Prozac, marketed under a different trade name because of the stigma of antidepressants) - insurance companies won’t pay for Sarafem, but they will pay for Prozac or its generic. I am 100% certain that there is going to be more and more of this type of “stealth” marketing of branded drugs in the future, with drug companies getting a new indication for a medication that has been out for a while and then rebranding it as a whole new drug. Also, for you consumers out there, there is a new trend which is quite troubling and becoming more prevalent. Drug companies that have lost their patents and now have generics to compete with them are beginning to reformulate their old drugs (that is, they modify the amount of each ingredient slightly) so that any prescription written for the brand drug must now be filled WITH the brand drug only, because the generic is no longer equivalent (case in point - Rynatan and Rynatan DM, a popular antihistamine/decongestant/cough suppressant). Since the MD is not likely to write out the specific ingredients with each of their strengths listed, the only choice if you want to pay for the generic for the old drug (which the MD meant), is that the pharmacist will have to call and get the Dr. to approve it, usually taking at least a full day. Sounds stupid, but it does increase the likelihood that you the consumer will say, “Ahh screw it, just give me the brand” and you pay an extra 10 bucks. Not that it is illegal, but who is to say that the makers of every brand drug that is just about to go off patent reformulate their drug and now there is no generic available for the brand drug. You can bet your Rx insurance premiums and copays will start climbing.
Karim Stino, PharmD.I didnt read the other replies because im too tired, but Ill give u a short, correct answer. The difference in name was Marketing, pure and simple. Just like smirnov and popov are vodkas poured from the same vats but offered at two prices. Smirnov is $1 more a fifth and is marketed to dumber people. Benadryl and Sominex are the exact same thing - Diphenhydramine. One is for allergies, the other for sleep- There is also a significant price difference for equal grade product. Reason? People put a higher value on being able to sleep than alleviating allergic symptoms (and learning that they require the same medicine). People want something that responds to their specific syptoms (like in the case of smirnov, the need to spend more money for the same thing :)). I should say that Wellbutrin is marketed for depression, while Zyban is marketed for smoking cessation. People dont want a drug that a doctor says is for depression but treats your problem too.
A smart doctor will prescribe Wellbutrin for either case because you can get the same dose and have it covered. Not being able to stop smoking can be pretty depressing huh? ;). Problem is finding a smart doctor.
AFAIC, the insurance companies have a totally legitimate beef in covering one and not the other. They assume that if your taking Zyban its because it is officially indicated for the cessation of smoking. Something they won’t cover. Wellbutrin is indicated for depression - something they will cover. The idiots here are the doctors. There is no law that says a drug can only be prescribed for the drug companies indicated symptoms. They should simply stop prescribing Zyban and that style of pharmaceutical marketing will become obsolete. Of course maybe these doctors own stock in insurance companies.
Sorry this wasnt short.
A smart insurance company will want to know the patient’s diagnosis before they will cover the medication. An even smarter doctor will not claim that a patient has a depressive disorder when he has made no such diagnosis, as this would be billing fraud, which is profoundly illegal.
Of course, depression is a rather “soft” diagnosis, so it usually isn’t a huge stretch. Still, one has to be careful.
Dr. J
Thanks, guys. With luck, my wife will be a nonsmoker in a few weeks. (And we won’t have to spend as much on the drug as she would have been spending on cigarettes!)
Doctor - A Smart Doctor! Your right should have worded via diagnostic differences rather than drug indication differences but I was trying to skirt the ethic/legal issue. 
KSpharm
Let me get this straight. When the drug companies create the new analog, do they stop offering the old? If not then the doc could just prescribe the old.
Indeed they do, KC.
This kind of thing is really out of hand with prenatal vitamins lately. A lot of my docs have started to write things like “Prenatal Vitamins that are covered by insurance” rather than “Materna” or “Stuartnatal” which may/may not be covered. They are starting to wise up and realize that one pet drug per class just isn’t enough b/c not all insurers cover every brand.
You’ve got your amen from over here in East TN, kspharm. I have a few insurance-company employees among my patients, and they get the same runaround the others do. At least they can see it from the patient’s point of view as well as the insurer’s. I just love it when they get hit with the newest innovation in copay technology: the $50 non-preferred brand. They can’t squawk without biting their own tail!
Do you mean Smirnoff?