Pharmacotherapy for Tobacco Treatment
The Standard of Care of tobacco treatment, regardless of the population or the type of tobacco used, is pharmacotherapy and counseling. Appropriate use of tobacco dependence medications reduces withdrawal symptoms and nearly doubles the chances of success for a given quit attempt. Delivering such treatments is cost-effective and is a key part of a multi-faceted approach to help patients stop smoking.
There are seven first-line medications that reliably increase long-term smoking abstinence rates.
Nicotine
- Nicotine patch
- Nicotine gum
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine inhaler (note that this is no longer available in the U.S.)
Non-nicotine
- Bupropion SR
- Varenicline
Clinicians should also consider the use of certain combinations of medications identified as effective in the Guideline.
- Long-term (>14 weeks) nicotine patch + other NRT
- The nicotine patch + the nicotine inhaler
- The nicotine patch + Bupropion SR
Table of Quit Medications from Rx for Change
Rx for Change, which draws heavily from the Clinical Practice Guideline for Treating Tobacco Use and Dependence, is a comprehensive, turn-key program for training students and licensed clinicians in virtually any health professional field.
To learn more about Pharmacotherapy for Tobacco Treatment, consider a virtual training offered by the Duke UNC Tobacco Treatment Specialist (TTS) Program.
Over-the-Counter NRT and Medicaid Coverage
When recommending or prescribing over-the-counter NRT (patches, gum or lozenges) for patients with NC Medicaid, you must ensure the selected product is rebatable and covered.
Medicaid plans are legally required to cover rebatable NRT products, but using the wrong product code (National Drug Code or NDC) can cause billing issues and prevent your patient from receiving their covered medication.
How to Ensure NRT is Covered for the Patient
Use the NC Tracks Search Bar to look up approved products:
- Access the Search Tool.
- Filter Results: Check the "rebatable" option.
- Search: Type "Nicotine" in the search field.
- Review: An exportable list of Medicaid-covered NRT brands will be provided.
Important: The list of covered products can change, so check back periodically to ensure accuracy.
Prescribing for Medicaid Recipients
To prevent confusion at the pharmacy and ensure your patient receives a covered product, follow one of these two recommended strategies when writing a prescription:
Direct Communication: Call the patient's chosen pharmacy and tell them to use one of the NDC-approved nicotine replacement options from the covered list. Or
Add a Note to the Prescription: Include the following instructions in the "Notes to Pharmacy" section of your NRT prescription for Medicaid recipients: "Pharmacy - Please fill with a Medicaid-covered NDC. For a current list, call NC Tracks at 1-800-688-6696."
Pharmacist-Dispensed Nicotine Replacement Therapy (NRT)
How It Works: No Doctor Needed
North Carolina has established statewide protocols through the NC Board of Pharmacy that allow authorized pharmacists to prescribe and dispense all FDA-approved Nicotine Replacement Therapy (NRT) products.
This means your patients can get essential quit-tobacco medications directly from their local pharmacy without needing a doctor's appointment. This removes a significant barrier to accessing treatment.
Key Document: View the official Nicotine Replacement Therapy Protocol for full details.
Immunizing Pharmacist Enrollment & Medicaid Billing
- The NC Board of Pharmacy protocols authorize immunizing pharmacists (those certified to administer immunizations) to dispense, deliver or administer NRT.
- To Bill NC Medicaid for Dispensing NRT per protocol, the immunizing pharmacist must:
- Enroll as an NC Medicaid provider using the Ordering, Prescribing, Referring (OPR) Lite application.
- Use their NPI (National Provider Identifier) as the prescriber on pharmacy claims for the NRT product.
- Use their NPI as the ordering provider on medical claims for any associated clinical services.