Tobacco Cessation Benefits and Health Coverage
Reports from businesses that added a tobacco cessation benefit have shown increases of smokers willing to quit. They've also shown increases in the percentage of smokers who quit successfully.
How Should Benefits Be Designed?
The Public Health Service-sponsored Clinical Practice Guidelines, Treating Tobacco Use and Dependence, and the Community Preventive Services Task Force recommend that all insurers offer tobacco cessation benefits. These benefits should do the following:
- Pay for counseling and medications, together or separately.
- Cover at least four counseling sessions. These should be at least 30 minutes each. They should include pro-active telephone counseling and individual counseling. While classes are also effective, few smokers attend them.
- Cover both prescription and over-the-counter nicotine replacement medications. This includes the patch, gum, lozenges, inhalers, nasal sprays, buproprion, varenicline, etc.
- Offer counseling and medication coverage for at least two attempts to quit per year.
- Drop or reduce co-pays or deductibles for counseling and medications. Even small co-payments reduce the use of proven treatments.
How Much Do Cessation Benefits Cost? Are They Cost-Effective?
Implementing a tobacco cessation program at your workplace can save you money. It is more cost-effective than other common and covered disease prevention interventions (for example hypertension and high blood cholesterol treatments).
Cost analyses have shown tobacco cessation benefits to be either cost-saving or cost-neutral.
Cost to employers equalizes at three years, while benefits exceed costs by year five.
Costs for comprehensive tobacco cessation benefits are between 10 and 40 cents per member per month. (Results may vary based on use and dependent coverage). In contrast, the annual employer cost of tobacco use is about $5,816 per year in medical costs, plus lost productivity.
Does Health Care Reform Change How Tobacco Cessation Is Covered?
As of Sept.23, 2010, new health plans in which an individual has enrolled since March 2010 are required to cover tobacco cessation counseling and medications with no co-pay or deductible. As of Oct. 1, 2010, all state Medicaid programs are required to cover cessation benefits for pregnant women with no cost-sharing.