Cost of Smoking Cessation Policies in Medicaid Worth the Investment

Medicaid programs throughout the country cover tobacco cessation therapies, but utilization of these benefits tends to be low and varies among states, according to a study published in the CDC’s Preventing Chronic Disease.

With Medicaid’s low-income beneficiaries roughly twice as likely to smoke as the general public, bolstering smoking cessation rates can help reduce healthcare costs.

“Efforts to reduce smoking by Medicaid beneficiaries are critical both to improve public health and lower healthcare costs in the United States, where smoking is the leading cause of preventable illness and death,” the authors wrote.

Every state now covers some Medicaid tobacco cessation benefits, but certain policies could restrict patient access to such help. The study examined Medicaid policies to find an explanation for state-level differences in the use of some cessation therapies, and the authors found that policies requiring patients to obtain counseling before they can get medications to help them quit smoking present a significant barrier.

State Medicaid agencies that require counseling reduced medication use by one-fourth to one-third, the authors found. Previous research has found that states that permit both counseling and medication not only had more attempts to quit smoking, but those states also had more successful quit attempts. However, requiring counseling had an unintended negative consequence. As such, the investigators recommend that patients be able to seek medications and counseling, but that one should not be required to access the other.

The researchers found that whether states covered all types of antismoking drugs—nicotine replacement therapies, such as gum, sprays, or patches; bupropion; and varenicline (Chantix)—had a significant impact on utilization of smoking cessation benefits within Medicaid.

“Offering more choices can enhance the demand for medications and increases the likelihood of finding medications meeting patients’ needs or clinicians’ judgement,” the authors wrote.

In contrast, cigarette taxes and smoke-free laws did not have significant impacts on the use of Medicaid tobacco cessation medication. The authors were surprised these 2 measures had little effect since previous research found them to be the most effective strategies when it comes to reducing smoking.

Overall, the authors determined that the investment to broaden Medicaid coverage for all approved medications is one that pays off in the long term as it prevents the higher cost of smoking-related diseases.

“The ultimate challenge is to empower patients and providers to increase awareness of cessation benefits and to enhance motivation and supports to undertake the difficult challenge of quitting, to improve health and to reduce healthcare costs,” the authors concluded.