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Does Medicare Cover Smoking Cessation Products

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Tenncare Now Covers Smoking Cessation Products For All Enrollees

Tobacco Cessation Coverage in Medicaid: What You Need to Know

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State Fiscal Year 2012 Begins Today

NASHVILLE The Bureau of TennCare announced today that medically necessary smoking cessation products are now covered for all enrollees in the program. Including the benefit in the TennCare fiscal year 2012 budget, is a positive step forward in Governor Bill Haslams initiative to assist Tennesseans in maintaining healthy lifestyles.

Not smoking is one of the best healthy choices Tennesseans can make, said Gov. Bill Haslam. I am pleased that smoking cessation assistance will now be more easily accessible to TennCare recipients. This is an important step to encourage Tennesseans to make healthier decisions, especially since TennCare covers nearly a quarter of the states population.

Previously this benefit was only available to pregnant women and enrollees under the age of 21, while all enrollees had access to smoking cessation counseling services through their primary care provider. The change in pharmacy benefits will cover both prescription and over-the-counter products for all enrollees and adults will be limited to a total of 24 weeks of smoking cessation medication each year. Exceptions will be made for pregnant women to allow for use throughout pregnancy, as appropriate.

TennCare is the State of Tennessees Medicaid program that provides health care insurance to approximately 1.2 million Tennesseans. TennCare operates under an annual budget of approximately 8.9 billion dollars.

Medigap Plans Can Help Cover Covered Medicare Tobacco Cessation Treatment

If Medicare covers your smoking cessation counseling or other treatment, you will typically have to pay certain out-of-pocket costs such as copays, deductibles and coinsurance.

A Medicare Supplement Insurance plan can help cover some of these costs.

For example, each of the 10 standardized Medigap plans that are available in most states provide coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered outpatient smoking cessation treatments.

A licensed agent can help you find a Medigap plan that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

1 10-minute claim is based solely on the time to complete the e-application if you have your Medicare card and other pertinent information available when you apply. The time to shop for plans, compare rates, and estimate drug costs is not factored into the claim. Application time could be longer. Actual time to enroll will depend on the consumer and their plan comparison needs.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

What About Part C Coverage

Medicare Part C is a plan where a Medicare beneficiary selects a private insurer to provide their Medicare Part A and Part B benefits. Many policies also offer Medicare Part D benefits as well.

Medicare requires Medicare Advantage plans to offer the same coverage level as original Medicare and stand-alone Part D plans. If you have Part D coverage through Medicare Advantage, your plan should cover Chantix.

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How Much Does Chantix Cost

When you have Medicare, your costs for Chantix may depend on how you pay for your medications and what coverage stage you are in.

According to GoodRx, Chantix costs about $8 to $9 for a copayment until youve met your deductible. After that time, Chantix usually costs anywhere from $1 to $9.

If youre wondering exactly what Chantix will cost you, you can visit the GoodRx website and enter information about your specific Medicare prescription drug plan by clicking the See My Plans Prices button.

These costs are estimates and may vary based on your plan, the pharmacy you use, and the amount in your supply.

You can also contact your plan to find a list of approved pharmacies or contact the pharmacy to find an estimated listing of costs.

Medicare Coverage For Smoking Cessation Treatments

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Home / FAQs / Medicare Coverage / Medicare Coverage for Smoking Cessation Treatments

Medicare coverage is available for smoking cessation treatments. Smoking puts you at risk for heart disease, lung disease, cancer, and a host of other conditions. Stopping smoking is one of the BEST things you can do for your overall health. But its easier said than done. If you speak to your doctor about quitting smoking, Medicare may pay for you to participate in a program that will help you give up smoking for good.

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How Does Chantix Work

Chantix is the brand name for the medication varenicline. Doctors prescribe this medication to help a person quit smoking.

Chantix isnt a nicotine replacement therapy. Unlike nicotine patches, gums, or sprays, Chantix doesnt contain nicotine.

Instead, Chantix works by attaching to receptors in your body that are stimulated when you smoke. These receptors are what give you that feel-good sensation when smoking. When the nicotine wears off, you start to crave another cigarette.

Chantix blocks nicotine from attaching to the receptors. It keeps it from giving you the same high and crash, which ideally will help you to quit more effectively.

Chantix has some side effects. These may include:

  • constipation
  • vomiting
  • problems sleeping

You should also talk to your doctor about any medicines and supplements you take to make sure they wont interact with Chantix.

Some people may use Chantix and nicotine replacement therapies together, but this may result in greater symptoms of abdominal upset.

Does Medicare Cover Chantix And Other Prescriptions

In addition to counseling, your doctor may prescribe a medication to help you stop smoking such as varenicline, also known by the brand name Chantix.

Since 2006, Medicare Part D drug plans have included certain smoking cessation drugs.

Smoking Cessation Drugs Covered by Medicare Part D

  • Nicotine replacement therapy inhalers
  • Nicotine replacement therapy nasal spray
  • Bupropion

Common over-the-counter medications, such as nicotine gum and patches, are not covered by Medicare.

However, certain Medicare Advantage plans may include some coverage or discounts on these products.

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State System Medicaid Coverage Of Tobacco Cessation Treatments Fact Sheet

Smoking is the leading preventable cause of premature death in the United States, resulting in about 480,000 deaths each year.1 More than 16 million Americans suffer from a disease caused by smoking.1 Adults enrolled in Medicaid smoke cigarettes at a rate more than twice as high as that of privately insured adults .2 Nationally, Medicaid spends about $40 billion on health care for smoking-related diseases annuallymore than 15% of total Medicaid spending.1 Smoking cessation improves health status, enhances quality of life, reduces the risk of premature death, and can add as much as a decade to life expectancy.3 Smoking cessation also reduces the substantial financial burden that smoking places on smokers, health care systems, and society.3

The traditional Medicaid population is by definition low-income, and therefore less able to pay out-of-pocket for tobacco cessation treatments than people with higher incomes. Medicaid enrollees are also less likely than higher-income people to be able to successfully navigate the system to overcome barriers to accessing cessation treatments.4

Evidence suggests that states could reduce smoking rates, smoking-related disease, and health care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use.3,6,7,8,9

What are Medicaid Programs Required to Cover for Tobacco Cessation?

How Does Medicare Pay For Smoking Cessation Counseling Visits

Approaches to Promoting Medicaid Tobacco Cessation: A Focus on Providers

Original Medicare is made up of Medicare Part A and Medicare Part B . Smoking cessation treatment is covered under your Part B benefits, and you may be eligible to get up to eight counseling sessions at no cost to you.

The following conditions for smoking cessation visits or counseling sessions apply:

  • The counseling sessions must be provided by a licensed physician or other Medicare-approved practitioner.
  • The eight sessions must occur in one 12-month period, and youre eligible for further counseling during the next 12-month period.

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Medicare Plans With Prescription Drug Coverage

If your physician prescribes prescription drugs to help with smoking cessation, please note that Original Medicare coverage of prescription drugs is limited, and generally doesnt cover medications you take at home. A stand-alone Medicare Prescription Drug Plan offered by a Medicare-approved private insurance company can help you cover the costs of prescription drugs. Youll have to check with the plan to make sure that the prescription drugs are on the plans formulary, which is a list of covered prescription drugs. Please note that the formulary may change at any time, and you will receive a notice from your plan when necessary.

There is another way to receive prescription drug coveragethrough a Medicare Advantage Prescription Drug plan. Some people receive their Original Medicare benefits through an alternative method called a Medicare Advantage plan . The vast majority of Medicare Advantage plans include prescription drug coverage, which may cover certain prescription medications used in smoking cessation. Again, please check the plans formulary.

What If I Need More Help Quitting Smoking

According to the CDC, quitting smoking is difficult and may require several attempts people who have tried smoking cessation may begin again because of withdrawal symptoms, stress, or weight gain. If you need help beyond the Medicare-covered smoking cessation counseling, you may have other options.

According to the CDC, the following ways have been proven effective for smokers who want help quitting:

  • Talking briefly to your doctor for advice
  • Attending individual or group counseling sessions, in person or by phone
  • Trying behavioral therapies like problem-solving training
  • Over-the-counter products like nicotine patches, gums, or lozenges
  • Prescription products like nicotine patches, inhalers, or nasal sprays
  • Prescription non-nicotine medications, like Zyban or Chantix
  • Please note that according to the CDC, counseling and medications are both effective for smoking cessation, and using them together is more effective than trying either one alone.

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    Remember: You’re Never Too Old To Quit Smoking Or Using Tobacco

    When you quit, you can look forward to these health benefits:

    3 days: nicotine has left your body

    1 year: risk of coronary heart disease cuts in half

    2-5 years: risk of mouth, throat, esophagus and bladder cancer cuts in half risk of stroke reduces to that of a non-tobacco user

    10 years: half as likely to die from lung cancer risk of kidney or pancreatic cancer decreases

    15 years: risk of coronary heart disease drops to a non-tobacco user’s

    Insurance Type: Medicaid Expansion

    Helping an Older Man Quit Smoking

    Who’s Covered?

    Low-income or disabled individuals, up to 138% of federal poverty level in states that expand Medicaid

    Required Coverage

    • Tobacco cessation as a preventive service. Federal guidance defines this as:
    • 4 sessions of individual, group and phone counseling
    • 90 days of all FDA-approved smoking cessation medications
    • 2 quit attempts per year
    • No prior authorization for treatments
    • No cost-sharing

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    Affordable Care Act: Coverage To Quit Smoking

    If you smoke or use any other type of tobacco, now is a great time to talk to your doctor. Under the Affordable Care Act, your health care plan* can give you the tools you need to quit.

    Quitting smoking or using any type of tobacco is one of the best things you can do for your health. Tobacco is linked to lung cancer and many other types of cancer, heart disease and stroke, COPD , lung disorders, vision problems, problems during pregnancy, gum disease, and many other serious health concerns. The sooner you stop, the quicker your body can start to recover.

    Most health care plans, including all plans purchased through the , cover screening about tobacco use, during which your doctor will ask if you smoke or use tobacco and offer you information on how it affects your health and why you should consider quitting.

    Your health care coverage may now include free programs to help you quit. Depending on your plan, that might include:

    • Counseling about how to stop smoking or using other types of tobacco
    • Stop-smoking drugs bupropion and varenicline
    • Nicotine replacement, such as gum, lozenges, skin patch, inhaler, and nose spray

    Pregnant women on Medicaid can also receive free counseling and treatment to help them stop smoking or using tobacco.

    If you are covered by Medicare, your smoking-related benefits include two opportunities each year to quit smoking or using any other type of tobacco. Each time you try to quit, your Medicare coverage includes:

    Insurance Type: Grandfathered Health Plans

    Who’s Covered?

    Individuals enrolled in a plan that was in existence before March 2010 and has not made significant changes since

    Required Coverage

    No requirements, but plans may opt to cover tobacco cessation treatment

    Cost-sharing: money a patient must pay when receiving treatment/filling a prescription: copays, coinsurance, deductibles, etc.

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    Medicares Coverage Of Smoking Cessation Counseling

    Tobacco use is the leading cause of preventable death in the United States.

    About 440,000 people die each year from smoking-related diseases, and 68 percent are age 65 or older.

    Older adults who quit smoking can reduce their risk of death from various conditions, including coronary heart disease, chronic obstructive lung disease and lung cancer.

    Smoking cessation counseling has been available as a Medicare-covered service since 2006.

    Medicare will cover up to two smoking cessation attempts each year.

    Each attempt includes a maximum of four counseling sessions, or a total of up to eight sessions in a 12-month period.

    During counseling sessions, a doctor or therapist will provide you with personalized advice on how to quit.

    Medicare smoking cessation counseling can help you:

    • Develop a plan to quit smoking.
    • Identify situations and environments that trigger your urge to smoke.
    • Find smoking alternatives and distractions, such as brushing your teeth or taking a walk.
    • Eliminate smoking products from your home and car, including lighters, matches and ash trays.
    • Learn about the health benefits of smoking cessation.
    • Practice coping mechanisms for emotional and physical withdrawal symptoms.

    You and your health care provider can choose between intermediate or intensive cessation sessions for each attempt.

    Intermediate sessions last more than three minutes but less than 10 minutes, while intensive sessions last more than 10 minutes.

    Prescription Aids To Help You Quit

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    Health Partners s and Health Partners Medicares pharmacy benefits cover smoking cessation prescriptions from a doctor. Over-the-counter medications may be another option. Members should check their plans formulary for the most up-to-date drug coverage. The Medicaid formulary and Medicare formularies are available online at any time.

    Note: Formularies are subject to change. Please call Member Relations if you have questions about your prescription benefits.

    Resources

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    Medicines To Quit Smoking Are A Covered Benefit

    You may find medicines and Nicotine Replacement Therapies helpful in your efforts to quit smoking and tobacco use. You may want to choose the nicotine patch, nicotine gum or nicotine lozenge. NRTs may be used along with the prescription medications bupropion or Chantix®.

    • Nicotine Patch, Gum or Lozenge: The nicotine patch, gum or lozenge can be sent directly to you upon request.
    • Bupropion and Chantix® are prescription products. Talk to your doctor to discuss whether bupropion or Chantix® is right for you. If it is, your doctor will give you a prescription.
    • Zyban®, a brand name for bupropion, is a prescription medication which can help ease withdrawal symptoms and the urge to smoke. Bupropion is also used to treat depression. However, you do not have to be depressed to take bupropion for smoking cessation. Bupropion is started while you are still smoking, with your quit-smoking date set for a week later.
    • Chantix® is a prescription medication which can help you stop smoking. You can start taking Chantix® one week before your quit smoking date. You can continue smoking during this time. Most people will keep taking Chantix® for up to 12 weeks. If you have completely quit smoking by 12 weeks, ask your doctor if another 12 weeks of treatment may help you stay tobacco free.

    * Medicare members will be responsible for a copay for the smoking-cessation prescription products.

    For more information about quitting smoking and tobacco use, the following resources can help:

    How Can I Get Help To Cover My Prescription Drug Costs

    The following programs may help you save money on your medications:

    • Medicaid. Medicaid is a state-run assistance program that can help you pay for medications if you have trouble affording them. to learn more about Medicaids state prescription drug resources.
    • Medicare Extra Help program. The Medicare Extra Help program provides prescription drug cost assistance for those who meet income qualifications. These criteria change on a yearly basis, so check your status each year.
    • Medicare savings programs. A Medicare savings program helps you pay for healthcare costs including prescription drugs. If you qualify for a savings program, you also automatically qualify for Extra Help.
    • Local community assistance programs. Several community organizations, including extensions of nonprofit chapters like the American Heart Association and the Program of All-Inclusive Care for the Elderly may provide assistance with medications.
    • Manufacturer coupons. Many prescription drug manufacturers offer discount coupons that you can either mail in after you use the coupon or submit directly to your pharmacy to save money on your medications.
    • Prescription drug discount websites. There are several websites that offer prescription drug discount cards or other information on medicine cost-savings. Examples of these include AmericasPharmacy, Choice Drug Card, GoodRx, and ScriptSave WellRx.

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    The Following Prescription Drugs Are Covered Through This Program When You Use A Preferred Retail Pharmacy:

    • Bupropion ER 150 mg tablet
    • Bupropion SR 150 mg tablet
    • Varenicline 0.5 mg tablet
    • Chantix 1 mg continuing monthly pack
    • Chantix 1 mg tablet
    • Nicotrol NS Spray 10 mg/ml
    • NicoDerm CQ Patch
    • Commit Lozenges

    To receive benefits for over the-counter smoking and tobacco cessation drugs, you must have a physician’s prescription for each OTC drug, which must be filled at a Preferred retail pharmacy.

    Regular prescription drug benefits will apply to smoking and tobacco cessation drugs not meeting these criteria.

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