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 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.
Benefits of Adopting the Recommendations
Health insurers who have invested in adopting the recommendations have seen significant cost savings and return on investment. The estimated cost for a health plan to provide full cessation coverage to its subscribers is approximately $2.64 to $5.40 more per enrollee per year (or $0.22 to $0.45 per enrollee per month).10, 11 Furthermore, the return on investment is significant. For example, in the Massachusetts Medicaid plan (MassHealth), for every $1 in program costs, an estimated medical savings of $3.12 was received, which equates to a return on investment of $2.12 for every dollar spent.12 Another study, an economic model of bupropion and a work-site smoking cessation program, found that for every dollar spent on a smoking cessation intervention, it was estimated that between $5 and $6.50 was saved when considering both direct and indirect costs.13 Considering just the money saved on health care, between $4 and $4.70 was saved per dollar spent.13
For further information or technical assistance regarding the adoption of the recommendations, please contact Karen Geletko at 850-645-1490 or firstname.lastname@example.org.
- Hopkins DP. Recommendations to improve targeted vaccination coverage among high-risk adults - Task force on community preventive services. American Journal of Preventive Medicine. Jun 2005;28(5):231-237.
- Fiore MC. AHCPR smoking cessation guideline: a fundamental review. Tob Control. 1997;6 Suppl 1:S4-8.
- Fiore MC, et al. Clinical Practice Guideline: Treating tobacco use and dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, Public Health Service; 2008.
- Schauffler HH. Defining benefits and payment for smoking cessation treatments. Tob Control. 1997;6 Suppl 1:S81-85.
- Fiore MC, et al. Clinical Practice Guideline: Treating tobacco use and dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, Public Health Service; 2008. [pdf]
- George Washington University Center for Health Services Research and Policy. Sample Purchasing Specifications Related To Tobacco-Use Prevention And Cessation: a Technical Assistance Document. October 2002. [pdf]
- Centers for Disease Control and Prevention, American Cancer Society, and Wellness Councils of America. Making Your Workplace Smokefree—A Decision Maker's Guide. 1996. [pdf]
- American Lung Association. Helping Smokers Quit: State Cessation Coverage; 2011
- Kofman M, Dunton, K., Senkewicz, MB. Implementation of tobacco cessation coverage under the Affordable Care Act: Understanding how private health insurance policies cover tobacco cessation treatments. Washington, D.C.: Georgetown Health Policy Institute;2012.
- Fitch K, Iwasaki, K., & Peyenson, B. Covering smoking cessation as a health benfit: A case for employers. 2006.
- Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med. Sep 3 1998;339(10):673-679.
- Richard P, West K, Ku L. The return on investment of a Medicaid tobacco cessation program in Massachusetts. PLoS One. 2012;7(1):e29665.
- Halpern MT, Khan ZM, Young TL, Battista C. Economic model of sustained-release bupropion hydrochloride in health plan and work site smoking-cessation programs. Am J Health Syst Pharm. Aug 1 2000;57(15):1421-1429.