Pharmaceutical Complex

Zyban Rising:
Smokers Thwart Insurance Carriers But Get What They Pay for

By James La Rossa Jr.

While the latest smoking cessation therapy utilizing the compound Zyban is making the rounds of newspapers and television news programs, its identical twin, bupropion, or Wellbutrin SR, is getting the lion’s share of the business.

In a curious twist of fate, doctors are writing prescriptions of the antidepressant Wellbutrin SR for their smoker patients instead of the nicotine addiction drug Zyban, because many insurance companies won’t cover addiction therapies, but will reimburse patients for depression. Knowing physicians are helping patients sidestep the formularies of some of the largest insurance carriers, who are denying reimbursement of Zyban for fear that this will open the floodgate of every kind of addiction therapy on the market. While the ends might certainly justify the means in these cases, the story of Zyban’s rise in Wellbutrin’s balloon illustrates perfectly the absurd ways of the health care insurance industry.

Of the bupropion twins—they are even the same grape color—Wellbutrin was the first born: in 1989 as a novel antidepressant that produces antidepressant effects primarily through enhancement of noradrenergic and dopaminergic neurotransmission without any appreciable serotonergic effects. In 1997, the younger twin, Zyban, was approved for the treatment of nicotine addiction. GlaxoWellcome, Zyban’s manufacturer, believes that primary care doctors are writing the majority of Wellbutrin prescriptions for smokers, while psychiatrists are sticking to Zyban, according to a Glaxo executive. This makes ample sense, since primary care doctors have become very insurance-savvy by necessity. According to a recent report in the Wall Street Journal, UnitedHealth Group instituted a price approval requirement for doctors prescribing Wellbutrin after the carrier noted a spike in Wellbutrin prescriptions following the release of Zyban—which UnitedHealth does not cover.

Consumers have also become insurance-savvy. Consider the baffling case of Merck & Co.’s hair loss product, Propecia. While Wellbutrin and Zyban cost virtually the same (Wellbutrin out-costs Zyban by $.08 per for 90 pills, according to a comparison on drugstore.com), Propecia and Proscar—Merck’s prostate drug—both of which have the identical active ingredient, finasteride—have frustrated consumers by the wide variance in price. Balding men have discovered that they can reduce their monthly cost of finasteride from $50 to around $15 by cutting-up 5 milligram Proscar pills to the recommended dose of Propecia. What’s more, insurance will cover Proscar, but not Propecia.

While insurers might object to getting stuck with the tab for these agents, when asked why they won’t reimburse patients for Zyban, but will cover the expense of Wellbutrin, managed care companies are at a loss for a logical explanation. Unlike the Propecia-Proscar dilemma, which concerns a cosmetic complaint, the health care benefit to a smoke-free society is enormous. Imagine, if you will, the prosecution of a physician for insurance fraud because she/he prescribed Wellbutrin instead of Zyban for smoking cessation patients. Put that in front of a jury, and the physician wins 10-out-of-10.