State medicaid coverage for tobacco-dependence treatment has room for improvement

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After surveying 50 states and the District of Columbia to document their 2009 Medicaid tobacco-dependence treatment coverage, the Center for Health and Public Policy Studies at the University of California, Berkeley, in partnership with the CDC, found that 47 programs offered the coverage. Since Medicaid enrollees have almost double the smoking rate of the general adult population — 37 percent versus 21 percent — insurers should provide better access and support for people who wish to quit smoking in order to improve public health and reduce medical expenditures.

But so far, only five states — Indiana, Massachusetts, Minnesota, Montana and Pennsylvania — offer coverage for all recommended pharmacotherapies (nicotine patch, bupropion or Zyban, nicotine gum, varenicline (Chantix), nicotine nasal spray, nicotine inhalers, and nicotine lozenges) and individual and group counseling for all Medicaid enrollees. In Massachusetts, this mandate resulted in a 26 percent decrease in smoking rates among the Medicaid enrollees.

Even though the currently approved list of nicotine replacement smoking cessation aids only have a small beneficial effect in helping smokers quit, ACSH's Dr. Gilbert Ross still believes that tobacco-dependence treatment is a good idea. “Tobacco-dependence treatments are one of few treatments that improve public health by reducing the toll of tobacco-related diseases. It’s unfortunate, though, that the cessation methodologies covered by Medicaid don’t work well, and when used as a combination therapy for up to a year, they still only improve smoking cessation rates by 10 to 20 percent.”

“Tobacco-dependence treatment is very cost-effective, and even though the aids used now are not the best, it’s still better than nothing. If you can help a few hundred thousand smokers quit, it’s a good thing,” adds ACSH's Dr. Elizabeth Whelan.

Unfortunately, four states — Georgia, Connecticut, Missouri and Tennessee — do not offer any coverage for tobacco-dependence treatment to their Medicaid enrollees, and if they could all fit, we’d tell them to go stand in the corner.

“We urge states to cover smoking cessation aids, and my hope is that at some point soon, coverage for smokeless tobacco products and snus, which have been shown to be safe and dramatically effective at improving cessation rates, would also be covered by Medicaid,” says Dr. Ross.