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Most Medicaid Programs Fail to Provide Unrestricted Access to Smoking Cessation Therapies
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November 6, 2009 — A national survey shows that although the majority of state Medicaid programs offer coverage for some form of tobacco-dependence treatment, the majority fall far short of a stated mandate to provide unrestricted access to approved therapies.
The report, with first author S. B. McMenamin, PhD, from the Center for Health and Public Policy Studies at the University of California–Berkeley, was published in the November 6 issue of Morbidity and Mortality Weekly Report.
The study reveals that only 6 states cover all of the effective pharmacotherapies and individual and group counseling, and only 2 states report providing access to tobacco-dependence treatments without any limitations or restrictions.
The authors note that to achieve a stated objective to expand Medicaid coverage of evidence-based treatments for nicotine dependency to all 51 Medicaid programs, 45 of these programs need to expand their coverage to include all pharmacotherapies approved by the US Food and Drug Administration, as well as behavioral therapies.
They point out that low-income populations, such as Medicaid enrollees, have substantially higher rates of smoking than the general population — 33% vs 20% — which translates into 4.7 million smokers in the Medicaid population.
"Because access to comprehensive tobacco-dependence treatments has been shown to increase quit rates, providing coverage for these treatments to all Medicaid enrollees would reduce smoking in the Medicaid population," they write.
It is estimated that Medicaid expenditures attributable to smoking total nearly $22 billion annually and represent 11% of total Medicaid expenditures.
According to the report, although smoking cessation therapies are highly cost-effective and cost-saving, coverage for tobacco-dependence treatments differ widely from state to state.
In addition, few programs offer unfettered access to tobacco-dependence treatment and place restrictions on therapy through copayments, stepped-care requirements, enrolment in counseling to obtain medication, limitations on the number of treatment courses, and not covering combined treatments.
"To improve cessation rates in low-income populations, Medicaid programs should remove these barriers and improve access to tobacco-dependence treatments," the authors write.
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