State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments—United States, 2015–2017

April 6, 2018 / Vol. 67 / No. 13

 

 


MMWR Introduction

Cigarette smoking prevalence (25.3%) among Medicaid enrollees is about twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death. Comprehensive coverage of evidence-based cessation treatments could increase quit attempts, use of cessation treatments, and quit rates. To monitor recent changes in state Medicaid cessation coverage, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications in state Medicaid programs during July 1, 2015–June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization.

State Medicaid programs can increase cessation among Medicaid enrollees by covering cessation counseling along with cessation medications; the combined use of these treatments is more effective in increasing quit rates than the use of either treatment alone. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking and smoking-related disease and federal and state health care expenditures.

MMWR Highlights

Trends in Medicaid Coverage of Smoking Cessation Treatments During 2015-2017

  • The number of states covering individual counseling increased from 31 to 33.
  • The number of states covering group counseling remained at 10.
  • The number of states covering all seven FDA-approved cessation medications for all Medicaid enrollees increased from 30 to 32.
  • The number of states covering all nine treatments for all Medicaid enrollees increased from 9 to 10.

Common Barriers to Medicaid Coverage of Smoking Cessation Treatments, 2015-2017

  • The number of states requiring copayments for at least one treatment for at least some Medicaid enrollees decreased from 34 to 24.
  • The number of states requiring prior authorization for at least one treatment for at least some Medicaid enrollees decreased from 39 to 38.
  • The number of states requiring enrollment in counseling as a condition of receiving medication for at least one medication for at least some Medicaid enrollees decreased from 20 to 16.
  • The number of states requiring stepped-care therapy for at least one treatment for at least some Medicaid enrollees remained at 19.
  • The number of states imposing limits on duration of treatments for at least one treatment for at least some Medicaid enrollees increased from 38 to 41.
  • The number of states imposing annual limits on quit attempts for at least one treatment for at least some Medicaid enrollees decreased from 36 to 34.

 

Full Text