Quit Smoking: Expanded Coverage in Health Plans
An Historic Benefit
In 2011, for the first time in the history of the Federal Employees Health Benefits (FEHB) program, all federal employees and retirees (as well as their spouses and dependents) have full access to evidence-based tobacco cessation treatments.
FEHB covers an estimated 8 million people, including 2.2 million active federal employees, 1.9 million retirees, and almost 4 million spouses and dependents. The U.S. Office of Personnel Management (OPM) estimates that about 18% of current federal employees, or about 400,000 people, smoke (compared with approximately 20% of the general population). FEHB enrollees who smoke now have access to the kind of cessation treatments that help smokers quit for good.
Previously, FEHB plans were encouraged, but not required, to provide comprehensive smoking cessation coverage, but benefits varied across plans. While all national FEHB health plans provided some cessation coverage, none provided comprehensive coverage. That is no longer the case. On April 7, 2010, The Office of Personnel Management sent out a call letter to insurance carriers in the FEHB program announcing expanded tobacco cessation coverage. The new coverage goes into effect in January 2011.
In this new benefit, all FEHB health plans are required to cover all seven FDA-approved cessation medications and individual, group, and telephone counseling—the treatments identified as effective in the U.S. Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update. The health plans are required to offer this coverage with no copayments, coinsurance, deductibles, or annual/lifetime dollar limits.
Medications and counseling are each effective on their own and become even more effective when used in combination. Smokers who use both medications and counseling can potentially double to triple their chances of quitting successfully. The FDA-approved first-line medications are as follows:
- Bupropion SR
- Nicotine gum
- Nicotine inhaler
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine patch
FEHB plans are required to cover at least two quit attempts per year, with a minimum of four counseling sessions of at least 30 minutes for each attempt. However, the new benefit will not cover over-the-counter cessation medications that are purchased directly by enrollees. Prescription medications and medications that are provided to enrollees as part of cessation counseling or a cessation program will be covered.
Challenges of Quitting
Nicotine is the psychoactive drug in tobacco products that causes dependence. Nicotine dependence is the most common form of chemical dependence in the United States. Most smokers are dependent on nicotine, and research suggests that nicotine is as addictive as heroin or cocaine. Quitting smoking is difficult and may require multiple attempts. Users often relapse because of stress, weight gain, and withdrawal symptoms such as irritability, anxiety, difficulty concentrating, and increased appetite.
Proven cessation treatments can help smokers ease withdrawal symptoms and succeed in quitting. Different medications and different forms of counseling work for different people. One size doesn't fit all. Making multiple options available enables smokers to find the specific treatment or combination of treatments that best suits their needs and that gives them the best chance of quitting for good.
The 2008 Clinical Practice Guideline concludes that "Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit." Most smokers try to quit several times before succeeding. Smokers can learn from previous quit attempts and be better prepared to overcome the specific challenges that tripped them up in the past. With continued encouragement and support, many of them will keep trying until they succeed. More than half of all Americans who once smoked have quit.
Importance of Quitting
Smoking is the leading preventable cause of death in the United States, killing more than 400,000 Americans every year. One out of every two long-term smokers will die from a smoking-related disease. For every person who dies from smoking, another 20 people are living with serious smoking-related chronic diseases. Smoking costs the United States $96 billion in medical expenses and $97 billion in lost productivity annually.
The FEHB expanded benefit is expected to result in increased use of proven cessation treatments, increased quit attempts, and increased cessation. Over time, this would be expected to result in lower smoking rates among FEHB enrollees, reduced smoking-related disease and death, and decreased smoking-related health care costs. The new benefit could also serve as a model for state governments and private employers.
Seventy percent of smokers want to quit, and 45 percent of smokers try to quit each year. Smokers who quit greatly reduce their risk for disease and premature death, improve their health and quality of life, and increase their life expectancy. Quitting smoking is the single most important action that smokers can take to protect their own health and their families' health.
All Forms of Tobacco
The new FEHB tobacco cessation benefit covers all forms of tobacco, including cigarettes, snuff, and chewing tobacco. The cessation benefit can help FEB enrollees who smoke and/or use smokeless tobacco quit for good.
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