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Behavioral Sciences & Social Medicine > Area Health Education Center

Tobacco and System Interventions: Healthcare Insurers

Importance to Healthcare Insurers

Health insurance coverage of tobacco cessation treatment increases both use of effective treatment and the number of successful quit attempts.1 The U.S. Public Health Service (USPHS) report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, recommends that health care insurers should “include [effective] smoking cessation treatments (both pharmacotherapy and counseling)…as paid services for all subscribers.”2,3 In 2010, the Affordable Care Act (ACA) took a major step to address the significant human life and financial costs of tobacco use in the U.S. by requiring insurance companies and employers to cover tobacco cessation treatment services recommended in the USPHS guidelines with no cost sharing. Unfortunately, private insurance coverage for tobacco cessation services is still relatively uncommon.4  

Recommendations

Recommendations for Insurance Health Plan Providers

Insurance providers are in a unique position to reduce the burden of disease associated with tobacco use in their subscriber populations by adhering to the following recommendations:    

Recommendation: Health insurance providers should include effective tobacco cessation treatments as paid or covered services for all subscribers.5

  • Seven medications and three types of counseling are recommended to treat tobacco dependency. Nicotine replacement therapies (NRTs) are available over-the-counter (patch, gum, lozenge) and by prescription (nasal spray, inhaler), while bupropion (Zyban) and varenicline (Chantix) are two non-nicotine, prescription-only options.5
  • The types of counseling include individual (either face-to-face or telephone) and group counseling.5 
  • Coverage should be provided for at least two cessation attempts per year.6
  • Having access to all these treatments increases the likelihood of successful cessation among tobacco users.5
  • Quit rates are higher when health insurance covers tobacco cessation treatments.5

Recommendation: Health insurance providers should remove arbitruary barriers that limit access to cessation treatments.5, 7   

  • Barriers that deny or limit treatment include:
    • Requiring co-pays;
    • Limiting the length, frequency or amount spent on treatments;
    • Requiring prior authorization;
    • Requiring quit attempts with one medication before trying another;
    • And requiring counseling to be paired with medication. 8
  • Conflicting and confusing contract language also may leave subscribers uncertain if tobacco cessation treatments are covered, which could discourage them from seeking these treatments.9
  • Removing barriers will encourage more people to use the benefit and successfully quit tobacco.