According to the Centers for Disease Control and Prevention (CDC), 30.4% of Medicaid enrollees smoke, compared to 14.7% of privately insured Americans, placing them at greater risk for diseases such as oral cancer. Yet these enrollees often face barriers in gaining access to smoking cessation treatments.
Evidence-based and effective cessation treatments include individual, group, and telephone counseling as well as 7 medications approved by the Food and Drug Administration (FDA). A government initiative known as Healthy People 2020 has called for all state Medicaid programs to adopt comprehensive coverage of these treatments.
All states cover certain treatments for at least some Medicaid enrollees. But only 9 states—Connecticut, Indiana, Maine, Massachusetts, Minnesota, North Dakota, Ohio, Pennsylvania, and Vermont—cover all treatments for all enrollees. That’s an improvement since 2014’s tally of 6 states.
And even with access, common obstacles to getting that treatment for those on Medicaid include prior authorization requirements, limits on duration, annual limits on quitting attempts, and required copayments. Research indicates that removing all barriers and covering all treatments, promoting coverage, and monitoring treatment could reduce smoking prevalence, smoking-related morbidity, and smoking-related health care costs.
The 2010 Patient Protection and Affordable Care Act bars state Medicaid programs from excluding FDA-approved cessation medications from coverage. The CDC recommends that state Medicaid programs add these medications to preferred drug lists, remove barriers to their access, and add notices of coverage to public plan documents. Also, the CDC says state programs should cover counseling along with medication, as their combined use improves quit rates.
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