Smoking Cessation Therapies Can Save Lives and Lower Health Care Costs

Higher numbers of individuals would quit smoking if more cessation treatments were covered under state Medicaid programs, revealed the Centers for Disease Control and Prevention (CDC) in a study published by the agency’s Morbidity and Mortality Weekly Report. “There’s evidence suggesting that smokers enrolled in Medicaid, like other smokers, want to quit and will take advantage of covered cessation treatments to help them quit for good,” stated study co-author Stephen Babb, M.P.H.

Smoking Cessation Treatment Benefit

Currently, there are only seven states that cover all approved smoking cessation treatments for Medicaid recipients, including: (1) individual counseling; (2) group counseling; (3) nicotine patch; (4) nicotine gum; (5) nicotine lozenge; (6) nicotine nasal spray; (7) nicotine inhaler; (8) bupropion (Zyban®); and (9) varenicline (Chantix®). Further, all states have some barriers to getting such treatment, including: limiting the length of time treatment is covered; the amount covered on an annual basis; prior authorization requirements; and copayments. The study, which compared 2008 state specific Medicaid coverage data for tobacco cessation treatments to 2014 data, discovered that 41 states made changes to their coverage. Specifically, research found that 19 states exclusively increased treatment options; eight states exclusively reduced treatments covered under their Medicaid plans; and 14 states added and removed treatments from coverage.

Positive Results

According to the results, “states can save lives and reduce costs by providing Medicaid coverage for all proven cessation treatments, removing barriers to accessing these treatments, and promoting the expanded coverage,” stated CDC Director Tim McAfee. This was most evident in the state of Massachusetts, one of the seven states that offer all nine cessation treatments in their Medicaid policy, where the smoking rate among the state’s Medicaid population dropped from 38 percent to 28 percent. In addition, the state reported an almost 50 percent drop in hospital admissions for heart attacks and other acute heart disease diagnoses among Medicaid beneficiaries that used the benefit. The state also discovered a positive return on investment, as Massachusetts saved $3.12 in medical costs for every dollar spent on the cessation treatment benefit. “It is important that all smokers who want help quitting, including smokers enrolled in Medicaid, have access to proven cessation treatments and services,” said Babb.

Affordable Care Act

There are multiple provisions of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) that expand Medicaid cessation coverage, noted the study’s authors, including: (1) requiring state Medicaid programs to cover cessation counseling and pharmacotherapy for pregnant women without cost-sharing; and (2) barring states from excluding FDA-approved cessation medications from coverage. However, the study notes that the impact of the latter provision depends on how states implement it, how states add such medications to preferred drug lists, and how states remove barriers for beneficiaries to access those medicines. “If states take advantage of its full potential, the provision of the [ACA] that took effect in January 2014 barring state Medicaid programs from excluding cessation medications from coverage might greatly facilitate progress” in reducing smoking rates, stated the study.