Will Medicaid cover Wellbutrin XL (bupropion) 150 mg, taken as 2 capsules daily in the morning?

Medicaid Coverage for Wellbutrin XL 150 mg (2 Capsules Daily)

Medicaid typically covers bupropion (Wellbutrin XL) 150 mg at a dosage of 2 capsules (300 mg) daily in the morning, as this is within standard FDA-approved dosing guidelines for depression treatment. 1

Coverage Considerations

• Wellbutrin XL (bupropion extended-release) is commonly prescribed at an initial dose of 150 mg once daily, with a maintenance dose of 150-300 mg once daily 1
• The 300 mg daily dose (two 150 mg capsules) is a standard therapeutic dose for major depressive disorder 1
• Maximum recommended dose is 450 mg per day for Wellbutrin XL, so the requested dose of 300 mg daily is within safe prescribing limits 2, 1

Formulation and Administration

• Wellbutrin XL is designed for once-daily dosing in the morning 1
• Taking both capsules at the same time in the morning is appropriate for this extended-release formulation 1
• To minimize risk of insomnia, XL formulation should be taken in the morning rather than later in the day 2, 1

Clinical Considerations

• Bupropion has a unique mechanism of action compared to other antidepressants, with effects on norepinephrine and dopamine rather than serotonin 3
• It is generally well-tolerated with fewer sexual side effects than SSRIs 4
• Common side effects include dry mouth, insomnia, headache, and nausea 3, 4

Important Precautions

• Bupropion should be avoided in patients with seizure disorders as it may lower seizure threshold 1, 5
• Should not be used concurrently with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1
• Dose adjustments may be required for patients with moderate to severe hepatic or renal impairment 1

Medicaid-Specific Considerations

• While Medicaid formularies vary by state, bupropion is generally covered as it is an established first-line treatment for depression 4
• Some states may require prior authorization, especially for brand-name Wellbutrin XL versus generic bupropion XL 1
• If coverage issues arise, your healthcare provider can submit documentation supporting medical necessity 1

Alternative Options if Coverage Issues Arise

• Generic bupropion XL is typically covered more readily than brand-name Wellbutrin XL 1
• Bupropion SR (sustained-release) formulation may be an alternative, though it requires twice-daily dosing (150 mg twice daily) 2, 1
• Your healthcare provider can help navigate coverage options if the XL formulation is not covered 1