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State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage (CDC)

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On October 29, the U.S. Centers for Disease Control and Prevention (CDC )(reported findings from data collected by the American Lung Association, on coverage of all evidence-based cessation treatments except telephone counseling) by State Medicaid programs (nine treatments), and data on the barriers to access these treatments. The report was published in the CDC’s Morbidity and Mortality Weekly Report. The data ranged from December 31, 2008 to January 31, 2014, including all 50 states and the District of Columbia, with data collecting through internet websites and documents including Medicaid provider websites and handbooks, and Medicaid policy manuals.

Only nine states cover all nine-evidence based cessation treatments (an increase from six states in 2014). The report stresses that state Medicaid programs need to maximize tobacco cessation among Medicaid enrollees by covering all evidence-based cessation treatments, removing barriers that impede access to these treatments, promote their coverage to Medicaid tobacco users and health care providers, and monitor the use of covered treatments.

New Jersey’s coverage includes (for 2014, 2015):

  • Nicotine Patch
  • Nicotine Gum
  • Nicotine Lozenge (2015)
  • Nicotine Nasal Spray (2015)
  • Nicotine Inhaler (2015)
  • Bupropion (Zyban)
  • Varenicline (Chantix) (2015)
  • Individual Counseling (2015)

New Jersey’s barriers include (for 2014, 2015):

  • Copayments required varies by plan
  • Prior authorization required varies by plan
  • No counseling required for medications
  • Stepped-care therapy not included
  • Limits on duration varies by plan
  • Annual limit on quit attempts varies by plan
  • Lifetime limit on quit attempts varies by plan
  • Group Counseling not covered

The full study and findings conducted by the American Lung Association can be read here.

The MMWR article and highlights can be read here.