Smoking Cessation Programs Need a Boost Under Medicaid Expansion

According to this week’s Morbidity and Mortality Weekly Report by the CDC, Medicaid expansion states should direct more attention to smoking cessation programs to improve access, raise awareness about these programs among beneficiaries and providers, and simultaneously monitor use of these treatments.

Medicaid enrollees are more susceptible to smoking-related disease and mortality—more than double the number of Medicaid enrollees (27.8%) were documented as current smokers in 2015, compared with those on private health insurance (11.1%). This impacts not just the individuals, but the healthcare costs faced by Medicaid, as well. Medicaid spent more than $39 billion annually on smoking-related diseases during the period between 2006 and 2010.

Preventive smoking cessation treatments, including counseling and FDA-approved treatments, have been proven successful in helping individuals quit—provided they are covered by insurance. According to the report, 32 states that had expanded Medicaid eligibility under the Affordable Care Act covered some form of smoking cessation treatment for all expansion enrollees, as of July 1, 2016, and 9 states covered all 9 forms of cessation treatments (individual or group counseling, plus the 7 FDA-approved treatments).

The American Lung Association gathered data on cessation coverage that was accessible to the state Medicaid expansion population up until July 1, 2016. The data were compiled from compiled data from Medicaid member websites and handbooks, Medicaid provider websites and handbooks, policy manuals, plan formularies and preferred drug lists, Medicaid state plan amendments, and relevant regulations and legislation.

The study reports that 2.3 million newly eligible adults were a part of the 3.3 million adult cigarette smokers enrolled in Medicaid expansion coverage as of December 2015. As of July 1, 2016, 9 states (Colorado, Connecticut, Indiana, Massachusetts, Minnesota, North Dakota, Ohio, Pennsylvania, and Vermont) covered all 9 treatments for the Medicaid expansion enrollees, 17 covered individual counseling for expansion enrollees, 11 covered group counseling for all enrollees, and 19 covered all 7 FDA-approved smoking cessation drugs for all enrollees. The treatments include:

• Nicotine patch
• Nicotine gum
• Nicotine lozenge
• Nicotine nasal spray
• Nicotine inhaler
• Bupropion
• Varenicline

The report found that all 32 states had at least 1 barrier on at least 1 treatment for some of the enrollees. Copayments for at least 1 cessation treatment were required in 6 states for all enrollees; 7 states required copayments for some enrollees. Twelve states mandated prior authorization for access to at least 1 cessation treatment for all enrollees, and 14 states needed prior authorization for some enrollees.

The report concluded that comprehensive state Medicaid coverage increases use of cessation medications and increases rate of quitting. It also indicates that removing barriers to access, such as copayments and prior authorization, is important. Raising awareness among care providers and smokers about health plan coverage of these treatments is equally important, the report states.

Reference

DiGiulio A, Haddix M, Jump Z, et al. State Medicaid expansion tobacco cessation coverage and number of adult smokers enrolled in expansion coverage—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:1364-1369. doi: http://dx.doi.org/10.15585/mmwr.mm6548a2.