State Medicaid Coverage for Tobacco-Dependence Treatments—United States, 2009

October 22, 2010 / Vol. 59 / No. 41

MMWR Highlights

Pharmacotherapy Coverage by State Medicaid Programs in 2009

• 47 programs covered at least one tobacco-dependence treatment for some Medicaid enrollees.
• 38 programs covered some form of pharmacotherapy for all Medicaid enrollees—
  
  • 34 covered the nicotine patch.
  • 33 covered bupropion or Zyban.®
  • 32 covered nicotine gum.
  • 32 covered varenicline or Chantix.®
  • 28 covered nicotine nasal spray.
  • 27 covered nicotine inhalers.
  • 25 covered nicotine lozenges.

• 4 programs offered no coverage for tobacco-dependence treatment to their enrollees (i.e., Connecticut, Georgia, Missouri, and Tennessee).
• The most commonly covered combination of tobacco-dependence treatments were—
  
  • Nicotine patch and bupropion SR (33 programs).
  • Nicotine patch and gum (21 programs).
  • Nicotine patch and inhaler (21 programs).
  • Nicotine patch and nasal spray (19 programs).
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Counseling Coverage by State Medicaid Programs in 2009

• Medicaid programs covered counseling less often than pharmacotherapy.
• Medicaid coverage of individual counseling varied across programs.
  
  • 18 programs covered all Medicaid enrollees.
  • 6 programs covered FFS enrollees (with 2 restricting coverage to pregnant women only.
  • 1 program covered MCO enrollees.
  • 6 programs covered pregnant women only.
• Medicaid programs covered group counseling less often than individual counseling in some cases.
  
  • 8 programs covered all Medicaid enrollees.
  • 3 program covered FFS enrollees (with 2 restricting coverage to pregnant women only).
  • 2 programs covered MCO enrollees.
  • 5 programs covered pregnant women only.
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Combination Coverage by State Medicaid Programs in 2009

• 5 programs covered all recommended pharmacotherapies and all counseling for all Medicaid enrollees (i.e., Indiana, Massachusetts, Minnesota, Montana, and Pennsylvania).
  

Varying Access to Treatment

• Because some states reported different coverage policies for FFS enrollees, MCO enrollees, and pregnant women, Medicaid recipients within a state might have varying degrees of access to tobacco-dependence treatments.
  

Health Care Reform

• Recent federal policy is increasing access to smoking cessation treatments.
  
  • Section 4107 of the Affordable Care Act requires Medicaid programs to cover tobacco-dependence treatments for pregnant women, with no cost-sharing, starting October 1, 2010.
  • Section 4106 of the Affordable Care Act permits Medicaid programs to cover the A and B level recommendations of the U.S. Preventive Services Task Force, including cessation counseling and all FDA-approved tobacco-dependence treatments. States that offer such benefits and adult vaccination benefits, and prohibit cost sharing on these benefits, will receive a one full percentage point increase in the Medicaid federal medical assistance percentage for expenditures on these services, effective January 1, 2013.
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Future Implications

• To increase the impact of the federal legislation, it is important that Medicaid programs inform their enrollees and providers about changes in coverage for tobacco-dependence treatments and offer these treatments without barriers or limitations.
• Future monitoring of Medicaid programs should include measuring of usage rates of tobacco-dependence treatments and assessing of any existing coverage barriers.