Quitting Smoking? Know Your Rights to Get the Coverage You Need
This week marks the 38th year that the American Cancer Society has sponsored the Great American Smokeout, a day that encourages people to quit smoking tobacco. The day is also an annual reminder to the nation of the challenges smokers face when they try to quit smoking.
In an attempt to reduce these challenges and make it easier and more affordable to quit smoking, the Affordable Care Act (ACA) included several new requirements for states and insurers. All insurance plans bought through healthcare.gov (or the state equivalent) must cover the seven drugs approved by the U.S. Food and Drug Administration (FDA) for tobacco cessation and make them available to customers without a deductible, co-pay or co-insurance. The drugs included in this new requirement are nicotine gum, patches, lozenges, inhalers and nasal spray, as well as bupropion (Zyban) and varenicline (Chantix).
A report by the American Lung Association (ALA) evaluated whether insurance plans offered through an exchange, like healthcare.gov or its equivalents, were in compliance with the ACA’s tobacco cessation requirements. The results were not good. Less than half of the plans evaluated included all seven medications on their list of covered medications, and less than one fifth of plans made drugs available to those looking to quit without a deductible, co-pay or coinsurance.
The ALA also reviewed coverage of smoking cessation treatments in state Medicaid programs. The findings show that, while some state Medicaid programs improved their coverage of smoking cessation treatments from August 2014 to June 2015, only 30 states covered all seven medications, and only nine states covered all seven medications plus individual and group counseling. Most states impose additional barriers that make accessing treatment difficult for Medicaid enrollees, including copays (34 states) and prior authorization requirements (39 states).
Not offering these benefits is a big problem. Almost 500,000 lives are lost each year due to tobacco. Studies show that medications, including the seven listed above, greatly increase a person’s chance of quitting tobacco. And as discussed previously on The Buzz, we know that quit rates are higher in states where Medicaid covered smoking cessation medications and did not charge copays for counseling. We know these medications work. It is critical that those who want to stop smoking have easy access to the tools they need to be successful, including medications.
Know Your Rights
Insurance companies and some state Medicaid programs are not complying with the rules. And many consumers are unaware that a health plan purchased through an exchange and Medicaid programs are required to cover these medications. Successful smoking cessation efforts are in everyone’s best interest. Smoking-related illness is estimated to cost the U.S. around $300 billion per year. Health insurers must start to comply with the law, and federal and state governments should make sure those buying insurance through the exchanges know their rights and have the information they need to make decisions about buying the best health insurance for them.
Margaret Raskob, MPH
Margaret Raskob is a freelance blogger.