Smoking Cessation

PHARM-13 Statement of Medical Necessity for Quantity Limits Override.

Smoking Cessation

Drugs

Quantity Limits

Chantix (Varenicline Tartrate) Dose-Pack Tablets

53 Tablets per 28 Days

Chantix (Varenicline Tartrate) 0.5mg and 1mg Tablets 

60 Tablets per 30 Days

Zyban (Bupropion HCL) 150mg SA Tablets 

100 Tablets per 50 Days