What Can You Expect To Pay Out Of Pocket?¶,*
Prescription Coverage
Maximum Anticipated Out of Pocket (per 30 day supply)
If insured with commercial prescription plan
$0
If insured with Medicare prescription plan
$50
If insured with Medicare but no prescription coverage
$50
If no prescription insurance
$50
If insurance does not cover brand name WELLBUTRIN XL®
$50

† For patients whose commercial prescription plan reimburses less than $100, patient will be responsible for paying $50 for 30 pills. For patients whose commercial prescription plan reimburses $100 or more, patient will pay $0 for a supply of 30 pills.

‡For patients insured with a Medicare prescription plan or insured with Medicare without prescription coverage and the co-pay/co-insurance is more than $50, your prescription will be processed as a cash-paying patient with a $50 co-pay amount and no claim will be submitted to your Medicare plan.

¶ No claim will be submitted to federal or state healthcare programs, including Medicare, Medicaid, VA, DOD, Tricare and Indian health. By participating in the Wellbutrin XL Guarantee program you agree that you will not submit a claim for Wellbutrin XL reimbursement by any federal or state health care program.

Put the Wellbutrin XL Guarantee Program to work for you today

Just 3 easy steps!
Click to Download

The WELLBUTRIN XL Guarantee Program is a unique cost saving program sponsored by Valeant Pharmaceuticals that guarantees your out-of-pocket cost and delivers your prescription directly to you.

3 Easy Steps to Enroll in the Program

  1. Print the enrollment form by clicking the download button above
  2. Bring the form with you to your next scheduled office visit. If you are not a current WELLBUTRIN XL patient, ask your healthcare provider if WELLBUTRIN XL is right for you. If so, your healthcare provider will complete the top section of the form and you will retain the bottom section.
  3. Contact Direct Success Pharmacy at 800-520-3185 to complete your WELLBUTRIN XL prescription per instructions on the bottom of the enrollment form.

Already Have a WELLBUTRIN XL Prescription?

Just contact Direct Success Pharmacy at 800-520-3185 and tell them you'd like to participate in the WELLBUTRIN XL Guarantee Program. Direct Success will work with you to submit your current prescription to participate in the program.

To Process Your WELLBUTRIN XL Prescription

You will need to call Direct Success Pharmacy at 800-520-3185 to complete the process. They will need the following additional information from you:

  • The address where you want the prescription sent
  • The address for your credit card statement
  • Insurance Card/Prescription Card
  • A valid Credit/Debit Card number, expiration date and security code for any fees not covered by your insurance
  • Refer to your Enrollment Form Number (if you have a current prescription and do not have an enrollment form, please inform Direct Success and they will work with you to submit your current prescription)

You should receive your prescription medication within 5–10 business days after submitting your prescription and providing all of the information outlined above. Most prescriptions are shipped using UPS (United Parcel Service).

If you have any questions or need a refill on your prescription please contact the Direct Success Pharmacy team at 800-520-3185 between 8:00 AM and 11:00 PM Eastern time, Monday through Friday.

Program Terms and Conditions:

All patients with a prescription for WELLBUTRIN XL who are cash-paying or who have commercial insurance that covers WELLBUTRIN XL are eligible for this program.

  • Patients with commercial insurance that covers WELLBUTRIN XL pay $0 per fill. Cash-paying patients pay $50 per 30 day supply. This offer is valid toward out-of-pocket expense only, excluding applicable taxes.
  • A valid prescription for brand name WELLBUTRIN XL is required for fulfillment.
  • Patients who have prescription coverage that is paid in part or in full, by any state or federally funded programs, including but not limited to Medicare, Medicaid, Medigap, VA, DOD or TRICARE, or reside in the state of Massachusetts are not eligible to participate in the $0 offer due to State and Federal Regulations. Patients are responsible for reporting receipt of program rewards to any private insurer that pays for or reimburses any part of the prescriptions filled with this program.
  • Offer is void where prohibited by law, taxed or restricted. This offer is good only in the US and Puerto Rico.
  • Valeant reserves the right to rescind, revoke or amend this offer any time, without notice.

Indication

WELLBUTRIN XL® (bupropion HCl) is indicated for the treatment of major depressive disorder.

Important Safety Information

WARNING
Suicidality and Antidepressant Drugs
Use in Treating Psychiatric Disorders: Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of WELLBUTRIN XL or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. WELLBUTRIN XL is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk in Treating Psychiatric Disorders, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use.)
Use in Smoking Cessation Treatment: WELLBUTRIN®, WELLBUTRIN SR®, and WELLBUTRIN XL are not approved for smoking cessation treatment, but bupropion under the name ZYBAN® is approved for this use. Serious neuropsychiatric events, including but not limited to depression, suicidal ideation, suicide attempt, and completed suicide have been reported in patients taking bupropion for smoking cessation. Some cases may have been complicated by the symptoms of nicotine withdrawal in patients who stopped smoking. Depressed mood may be a symptom of nicotine withdrawal. Depression, rarely including suicidal ideation, has been reported in smokers undergoing a smoking cessation attempt without medication. However, some of these symptoms have occurred in patients taking bupropion who continued to smoke.

All patients being treated with bupropion for smoking cessation treatment should be observed for neuropsychiatric symptoms including changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide. These symptoms, as well as worsening of pre-existing psychiatric illness and completed suicide, have been reported in some patients attempting to quit smoking while taking ZYBAN in the post-marketing experience. When symptoms were reported, most were during treatment with ZYBAN, but some were following discontinuation of treatment with ZYBAN. These events have occurred in patients with and without pre-existing psychiatric disease; some have experienced worsening of their psychiatric illnesses. Patients with serious psychiatric illness such as schizophrenia, bipolar disorder, and major depressive disorder did not participate in the pre-marketing studies of ZYBAN.

Advise patients and caregivers that the patient using bupropion for smoking cessation should stop taking bupropion and contact a healthcare provider immediately if agitation, hostility, depressed mood, or changes in thinking or behavior that are not typical for the patient are observed, or if the patient develops suicidal ideation or suicidal behavior. In many post-marketing cases, resolution of symptoms after discontinuation of ZYBAN was reported, although in some cases the symptoms persisted; therefore, ongoing monitoring and supportive care should be provided until symptoms resolve.

The risks of using bupropion for smoking cessation should be weighed against the benefits of its use. ZYBAN has been demonstrated to increase the likelihood of abstinence from smoking for as long as six months compared to treatment with placebo. The health benefits of quitting smoking are immediate and substantial. (See WARNINGS: Neuropsychiatric Symptoms and Suicide Risk in Smoking Cessation Treatment and PRECAUTIONS: Information for Patients.)

WELLBUTRIN XL® is not for everyone. There is a chance of having a seizure (convulsion, fit) with WELLBUTRIN XL®, especially in people with certain medical problems or who take certain medicines. The risk of having seizures increases with higher doses of WELLBUTRIN XL®. Tell your doctor about all of your medical conditions, especially if you have liver or kidney problems, and all the medicines you take. Do not take any other medicines while you are using WELLBUTRIN XL® unless your doctor has said it is okay to take them. If you have a seizure while taking WELLBUTRIN XL®, stop taking the tablets and call your doctor right away. Do not take WELLBUTRIN XL® again if you have a seizure.

Do not take with monoamine oxidase inhibitors (MAOIs), or medicines that contain bupropion like ZYBAN®**, which is used to help patients stop smoking. Some people get high blood pressure that can be severe while taking WELLBUTRIN XL®. The risk for high blood pressure may be increased if you also use nicotine replacement therapy (such as a nicotine patch) to help you stop smoking.

Who should not take WELLBUTRIN XL®:
Do not take WELLBUTRIN XL® if you:

  • Have or had a seizure disorder or epilepsy
  • Are taking ZYBAN® (used to help people stop smoking) or any other medicines that contain bupropion hydrochloride, such as WELLBUTRIN® Tablets or WELLBUTRIN SR® Sustained-Release Tablets.Bupropion is the same active ingredient that is in WELLBUTRIN XL®
  • Drink a lot of alcohol and abruptly stop drinking, or use medicines called sedatives (these make you sleepy) or benzodiazepines and you stop using them all of a sudden
  • Have taken within the last 14 days medicine for depression called a monoamine oxidase inhibitor (MAOI), such as NARDIL®** (phenelzine sulfate), PARNATE®** (tranylcypromine sulfate), or MARPLAN®** (isocarboxazid)
  • Have or had an eating disorder such as anorexia nervosa or bulimia
  • Are allergic to the active ingredient in WELLBUTRIN XL®, bupropion, or to any of the inactive ingredients

Possible side effects of WELLBUTRIN XL®:
The most common adverse reactions reported with WELLBUTRIN XL® are weight loss, dry mouth, nausea, difficulty sleeping, dizziness, and sore throat. Other common side effects include loss of appetite, skin rash, sweating, ringing in the ears, shakiness, stomach pain, agitation, anxiety, muscle pain, fast heartbeat, and more frequent urination.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You may also contact Valeant Customer Service at 1-800-556-1937.

**Trademarks are the property of their respective owners.

Please see full Prescribing Information, including Boxed Warning about suicidality and antidepressants, and Medication Guide

This information is not intended to replace professional medical advice. Only a doctor can diagnose and help you manage the treatment of your depression.

WELLBUTRIN XL is a registered trademark of GlaxoSmithKline.
 ©Valeant Pharmaceuticals North America LLC      WXL167-0413a