Kentucky in Action
Bobbye Gray from the Kentucky Tobacco Prevention and Cessation Program is a registered nurse and a trained expert in helping people quit using tobacco products. Each year, more than 8,900 people in Kentucky die of smoking-related illnesses.1 In addition, tobacco-related diseases among Kentuckians result in Medicaid and Medicare treatment costs of about $1.2 billion per year—or $300 for each of the 4 million people living in Kentucky.2
Bobbye and her tobacco control colleagues wanted to find new ways to reduce tobacco use among Kentucky’s Medicaid enrollees, many of whom have a low income, are disabled, or live in rural areas of the state.3,4
Kentucky’s five health care systems—or Managed Care Organizations (MCOs)—that serve people insured through Medicaid offered different levels of insurance coverage for help to quit using tobacco products. Many rural Kentuckians were unable to get the help they needed to quit because their insurance did not fully pay for every service. In 2015, the tobacco control program met with the Kentucky Department for Medicaid Services, the Medicaid Prevention Network’s Tobacco Cessation Affinity Group, and the MCOs to learn why MCOs were unable to consistently pay for patients to receive medications approved by the Food and Drug Administration (FDA) to help people quit using tobacco products. After a series of discussions, these MCOs agreed to cover all seven FDA-approved medications.
To increase quit rates, the tobacco control program approached the Kentucky Pharmacy Board in 2016 to discuss options to get help from pharmacists. Because Kentucky law did not allow pharmacists to prescribe medication to help people quit, the tobacco control program and the Kentucky Pharmacy Board helped pharmacists and doctors enter into collaborative care agreements so that pharmacists could recommend medication and provide brief counseling to help people quit.5
Working with the MCOs and the Kentucky Pharmacy Board were steps in the right direction. But people who go to their doctors for help to quit using tobacco products could be even more successful if they receive counseling in addition to using medication.6 Many doctors in Kentucky were unaware that tobacco-related counseling is billable under Medicaid and Medicare. To address that issue, the tobacco control program and its partners created charts outlining the coverage provided by MCOs to help people quit and the billing codes for tobacco-related counseling, which they gave to Kentucky’s Medicaid providers. Knowing which billing codes to use to get paid for counseling patients to quit may increase the likelihood doctors will offer the service, given the many demands on their time.
In 2017, the Kentucky legislature decided to formalize and expand the MCOs’ agreement related to insurance coverage for quitting tobacco. Now, for consistency, all MCOs, Medicaid, and commercial health plans in Kentucky are required to provide the tobacco insurance benefits recommended by the US Preventive Services Task Force—all seven FDA-approved medications and individual, group, and telephone counseling. In addition, the Kentucky Pharmacy Board changed its rules in late 2017.7,8 Now, pharmacists can provide medications without a prescription and do more extensive cessation counseling to help people quit, without the extra work of entering into collaborative care agreements with doctors.
These changes resulted from steps that the tobacco control program took with partners to help Kentuckians get treatment to quit using tobacco. This work was done with key funding from the Centers for Disease Control and Prevention to Kentucky’s tobacco control program. Kentucky’s efforts are helping to reduce the toll of tobacco and health care expenses in the Bluegrass state.
