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Request Free Home Delivery
E-mail or give a copy of this form to your healthcare professional to request your WELLBUTRIN XL prescription be processed by PhilRx for free home delivery.

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INDICATION
WELLBUTRIN XL® (bupropion hydrochloride extended-release tablets) is a prescription medicine used to treat adults with a certain type of depression called major depressive disorder, and for the prevention of autumn-winter seasonal depression (seasonal affective disorder).
IMPORTANT SAFETY INFORMATION
WARNING: CHANGES IN THINKING AND BEHAVIOR, DEPRESSION, AND SUICIDAL THOUGHTS OR ACTIONS
Suicidal Thoughts or Actions and Antidepressant Drugs
Antidepressants may increase the risk of suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment. Depression or other serious mental illnesses are the most important causes of suicidal thoughts and actions. People who have (or have a family history of) bipolar illness or suicidal thoughts or actions may have a particularly high risk. Pay close attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if symptoms such as anxiety, irritability, impulsivity, trouble sleeping, aggressive behavior or suicidal thoughts are new, worse or worry you. WELLBUTRIN XL has not been evaluated for use in patients under the age of 18.
You are now leaving the WELLBUTRIN XL website and are going to a website that Bausch Health does not operate and to which Bausch Health’s Privacy Policy does not apply. Bausch Health is not responsible for the content, format, maintenance, or policies of the website you are about to visit and does not endorse or monitor any content on such website.
Eligibility Criteria/Terms and Conditions: By using the WELLBUTRIN XL coupon, you confirm that you understand and agree to comply with the following terms and conditions of this offer:
- This offer is only valid for patients with commercial insurance.
- This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan or any other federal or state health care programs.
- You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer or other third party who pays any part of the prescription filled.
- This offer is good only in the United States of America (including the District of Columbia, Puerto Rico and the U.S. Virgin Islands) at participating retail pharmacies.
- This offer is not available for patients who live in California or Massachusetts and/or who have insurance coverage for prescriptions in either of these states.
- You must be 18 years of age or older to redeem this offer.
- You must present the coupon along with your prescription to participate in this program. You must activate the coupon before using by calling 1-855-330-1963 or by visiting www.wellbutrinXL.com.
- The coupon is good for use only with the products identified herein. No other purchase is necessary.
- This offer cannot be redeemed at government-subsidized clinics.
- The coupon is good for a maximum of 12 prescription fills.
- You are responsible for paying the first $5 for each eligible prescription fill using the coupon. The coupon has a maximum benefit, and the patient is responsible for all additional costs and expenses after maximum benefit limits are reached.
- The coupon and offer are not health insurance.
- The selling, purchasing, trading, or counterfeiting of the coupon is prohibited by law. Void if reproduced.
- This offer is not valid with other offers. The coupon has no cash value. No cash back.
- Bausch Health reserves the right to rescind, revoke, terminate, or amend this offer at any time, without notice.
- You understand and agree to comply with the terms and conditions of this offer as set forth above.
- This offer and coupon expire on 12/31/21.
- For questions call: 1-855-859-2966.
You are now leaving the WELLBUTRIN XL website and are going to a website that Bausch Health does not operate and to which Bausch Health’s Privacy Policy does not apply. Bausch Health is not responsible for the content, format, maintenance, or policies of the website you are about to visit and does not endorse or monitor any content on such website.