Reducing Out-Of-Pocket Costs for Evidence-Based Cessation Treatments
Reducing out-of-pocket costs for evidence-based cessation treatment involves implementing policies to
offer new benefits or change the level of benefits offered (for example, reduced copayments). Rural residents,
especially those with lower incomes, are more likely to be uninsured
or underinsured and to rely on public sources of health insurance. One
study found that focus group participants in a rural, Appalachian Kentucky community reported wanting to
use pharmaceutical aids during their quit attempts, but found the costs prohibitive. These
that they would be more likely to use medications if insurance covered the cost.
Currently, federal laws and rules require almost all types of health insurance plans to cover
tobacco use counseling and interventions without cost-sharing. These services may include screening for
tobacco use, tobacco counseling sessions, and all tobacco cessation medications (including both prescription and
over-the-counter medications) that are approved by the Food and Drug Administration (FDA).
Examples of Programs that Reduce Out-Of-Pocket Costs
Implemented in January 2011, the
cessation benefits for federal employees serves as a model of comprehensive,
evidence-based coverage for tobacco users. Services with lifetime coverage include counseling,
FDA-approved tobacco cessation medications, and 2 quit attempts per year. Beneficiaries
do not pay copays and coinsurance costs for covered cessation services.
Medicaid Cessation Benefit has led to an increase in use of cessation treatments,
reduced smoking rates, improved health outcomes, and decreased medical costs among beneficiaries.
These benefits were especially effective at improving outcomes among vulnerable, underserved, and
Oklahoma's Medicaid program, SoonerCare,
identified the cost of medication copayments and the burden of prior authorization as barriers that
prevented Medicaid enrollees from accessing tobacco cessation treatments. The Oklahoma Health Care
Authority, the Oklahoma State Department of Health, and the Oklahoma Tobacco Settlement Endowment Trust
worked together to make a case for decreasing these barriers to treatment. On September 1, 2014, SoonerCare
eliminated tobacco cessation medication copayments and prior authorization requirements.
The Vermont Department of Health Tobacco Control
Program conducted research that found rural Vermonters of low socioeconomic status were
more likely to use tobacco products than the overall population. In order to help increase access to
effective tobacco cessation services for this population, the program worked with the Vermont Medicaid
office to activate CPT codes for tobacco counseling for individuals and groups, and engages in outreach to
providers to increase the code use.
Considerations for Implementation
Rural program planners may need to raise awareness of tobacco cessation benefits among tobacco
users and healthcare providers in their communities. Many people are unaware of their options and cessation
benefits are consistently underused. Proactive promotion of cessation coverage will increase
the chances that tobacco users and health providers access these benefits.
The Centers for Disease Control and Prevention funded the American Lung
Association to provide technical assistance to state tobacco control programs in their efforts to
promote comprehensive coverage of cessation treatments among private and public insurers. The
American Lung Association maintains a database
that demonstrates smoking cessation coverage per state.
Program Clearinghouse Examples
Resources to Learn More
Interventions, Best Practices for Comprehensive Tobacco Control Programs – 2014
Cessation interventions are one component of comprehensive tobacco control programs. This chapter, from CDC's
evidence-based guide on comprehensive, population-based approaches to tobacco control, presents information,
examples, and resources to guide cessation activities with the goals of promoting systems change, expanding
insurance coverage and use of cessation services, and supporting quitlines.
Organization(s): Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on
Smoking and Health
Tobacco Use Cessation Treatments
Gives a brief overview of tobacco's health and economic burden, available cessation
treatments, and the current status of cessation coverage for private and public insurance.
Organization(s): Centers for Disease Control and Prevention
An Evidence-based Cessation Strategy
Using Rural Smokers' Experiences with Tobacco
This article focuses on the experiences of current and former smokers living in an economically
disadvantaged area of rural Kentucky.
Author(s): Butler, K., Hedgecock, S., Record, R., Derifield, S., McGinn, C., Murray, D.,
& Hahn, E.J.
Citation: The Nursing Clinics of North America,47(1), 31–43
for Smoking Cessation Therapy: A Healthcare Practitioner's Guide, 3rd Edition
This guide gives an overview of tobacco cessation treatments, public and private sector initiatives,
and information on obtaining reimbursement.
Organization(s): Professional Assisted Cessation Therapy (PACT)
Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2014–2015
This article describes the state of Medicaid tobacco cessation coverage in the United States and
barriers to accessing treatments.
Citation:Morbidity and Mortality Weekly Report (MMWR), 64(42),1194-9
Organization(s): Centers for Disease Control and Prevention
Treating Tobacco Use and Dependence:
These resources are geared toward clinicians, system decision-makers, and tobacco users.
Organization(s): Agency for Healthcare Research and Quality
Afford to Quit Smoking
This case study provides an overview of federal employees' health benefits for tobacco cessation.
Experiences related to program implementation, communication, and next steps are discussed.
Organization(s): U.S. Office of Personnel Management, Partnership for Prevention