Helping Smokers on Medicaid QuitSeptember 16, 2014

Paul G. BillingsSenior VP, Advocacy & Education

Questions to Answer

• Why?• What is a comprehensive cessation benefit?• How has ACA changed things?• What are states doing?• What should my state do?

Background

Lyndsay Moseley

Brevity - highlight the themes and 1 or 2 examples?

Toll of Tobacco• 43.6 million Americans smoke • 273 billion cigarettes sold• 480,000 premature deaths• $333 billion in annual health costs• 5.6 million of today’s children under age 18 will

die prematurely

Quit Attempts

• The American Lung Association conducted research to better understand motivators to quit smoking and the number of attempts it typically takes American adults to quit.

• The survey found that 6 out of 10 former smokers were not able to successfully quit on their first try and required multiple attempts to quit smoking for good.

Why Help Smokers on Medicaid Quit?

People on Medicaid smoke at higher rates than the general population

Smoking Rate of Population Ages 18-65, 2012

National Health Interview Survey, 2012. Data analyzed by American Lung Association

General Population

Enrolled in Medicaid

Uninsured

18.1 percent 30.1 percent 29.6 percent

• Low-income Medicaid beneficiaries are less able to pay for treatments on their own

• Other factors that make it harder to access treatment:

Why Help Smokers on Medicaid Quit?

• Lack of extra time• Lack of transportation• Shortage of doctors that take

Medicaid• Other complicating health

factors• Low literacy levels/English as a

second language

Helping smokers on Medicaid quit saves lives

Why Help Smokers on Medicaid Quit?

Short-Term Reductions•Pregnancy & childbirth complications (low birth weight, SIDS)•Heart attacks•Asthma attacks•ER visits

Long-Term Reductions•Lung cancer•COPD•Heart Disease•Other cancers

Helping smokers on Medicaid quit saves money

–Smoking-related disease costs Medicaid programs an average of $833 million per state per year–Return-on-investment as high as 3-to-1 has been shown

Why Help Smokers on Medicaid Quit?

Massachusetts

• Implemented a model benefit in 2006

• Within the first two years:– 40 percent (75,000 people)

Medicaid enrollees used the benefit

– 26 percent reduction in Medicaid smoking rate

Massachusetts

Cost savings:•Risk of heart attack hospitalizations dropped 46 percent•Risk of hospitalization for other acute coronary heart disease diagnoses dropped 49 percent•For every dollar spent on the benefit, the state saved $3

Comprehensive Benefit

• 7 medications– 5 NRTs– Bupropion– Varenicline

• 3 types of counseling– Individual (face-to-face)– Group– Phone

• Easy to access/no limits

Barriers to Access

• Cost-sharing• Prior authorization• Duration limits• Yearly or lifetime limits• Dollar limits• Stepped care therapy• Required counseling

Affordable Care Act

Traditional Medicaid – Tobacco Cessation

• September 2010: comprehensive tobacco cessation benefit required for pregnant women with no cost sharing

• January 1, 2014: States are no longer able to exclude tobacco cessation medications– What will this mean in implementation?– Watch barriers, preferred drug

lists/formularies

Requirements for Medicaid Expansion

Plans offered to expansion population must cover the Essential Health Benefit

Preventive services with no cost-sharing

Tobacco Cessation FAQ Guidance

Tobacco Cessation FAQ*

• 4 sessions of individual, group and phone counseling

• 90 days of 1 of the FDA-approved smoking cessation medications, when proscribed

• No cost-sharing• No prior authorization• At least 2 quit attempts per year

* HHS, Labor and Treasury

What are States Doing?

Barriers-Traditional Medicaid

What Should My State Do?

• Cover all treatments• Remove as many barriers as possible

– Copays!

• Promote cessation benefits and encourage smoking cessation

• Adequately fund state quitline

Resources

Toolkit on Cessation Coverage:

www.lung.org/acatoolkit

– Helping Smokers Quit – state by state information– Factsheets– Additional Resources