Exchange plans fail to offer required smoking cessation coverage

April 1, 2015

The overwhelming majority of state health insurance marketplace plans are not providing required coverage for smoking cessation, according to a new report from the American Lung Association.

Millions of Americans who have enrolled in health insurance marketplace plans should be provided with free tools to quit smoking, but a new report from the American Lung Association shows fewer than 20% of plan issuers are providing the appropriate coverage.

The report shows that only 60 plan issuers out of 348 (17%) are covering tobacco cessation medications with no cost-sharing as required in the Affordable Care Act (ACA) and fewer than half of issuers list those seven approved cessation medications on their publically available drug lists, or formularies. Only one state, West Virginia, had all plans in the marketplace covering all tobacco cessation medications. West Virginia has only one plan issuer selling plans in its marketplace.

“Plans in state marketplaces are not providing access to medication and counseling to help smokers quit, despite the fact that the ACA requires smoking cessation coverage,” says Jennifer Singleterry, director, national health policy, American Lung Association. “When insurance plans don’t provide comprehensive coverage to help smokers quit, it is a major missed opportunity to save lives and healthcare dollars.”

Related:Annual screenings for older, long-term smokers will now be covered by Medicare

According to the ACA and federal guidance, all plans should cover a comprehensive tobacco cessation benefit:

  • At least four sessions of individual, group and telephone cessation counseling

  • All FDA-approved tobacco cessation medications (nicotine patch, gum, lozenge, nasal spray and inhaler; bupropion and varenicline)

  • At least two quit attempts per year

  • No cost-sharing, like copays, coinsurance or deductibles

  • No prior authorization requirements.

“All private health insurance plans that are not grandfathered – including many run by managed care decision-makers – are required to cover tobacco cessation treatments with no cost-sharing by the ACA. This report discusses this requirement and how plans sold in state marketplaces are following it,” Singleterry says. “It is crucial that all health insurance plan cover a comprehensive benefit to help smokers quit. Not only does the ACA and federal guidance require it, but it will save lives and money.”

Singleterry advised that executives should ensure that their plan(s) are covering all seven tobacco cessation medications and individual, group and phone cessation counseling with no cost-sharing and no prior authorization.

“Furthermore, make sure the tobacco cessation medications are each listed on your publically-available formularies, and that is clear that these medications are provided with no cost-sharing for the patient. It is important for patients and their healthcare providers to know this information up-front,” she says.

Tobacco use is the number-one preventable cause of disease and death in the United States, and is responsible for almost 500,000 deaths each year. Tobacco use costs our country over $289 billion annually in smoking-related healthcare expenses and lost productivity. Almost 70% of smokers want to quit.