Alot of people don’t realize that Smoking Cessation programs are required under PPACA. Here are some details from Blue Cross Blue Shield of SC. Each company is slightly different but it gives you and idea of how it works.
Who it Covers:
The Affordable Care Act (ACA) mandates coverage of tobacco cessation products for members participating in non-grandfathered plans purchased after March 23, 2010. This coverage is already in effect for members with grandfathered plans purchased before March 23, 2010 and ACA plans.
Please note: Product coverage applies to Individual and Group plan holders.
How it Works:
We cover certain tobacco cessation products at zero ($0) member cost share . We developed our program based on accepted national smoking cessation treatment guidelines. Members participating in non-Marketplace plans will need to request prior authorization for coverage of these drugs in order to promote the safe and cost-effective use of the available therapies.
The tobacco cessation drugs we cover at zero member cost share ($0) are:
- Prescription-only bupropion 150mg (generic Zyban)
- Prescription-only Chantix
- Prescription-only nicotine nasal spray or inhalers (ex: Nicotrol NS and Nictorol inhaler)
- Over-the-counter (OTC) nicotine patches/transdermal systems (ex.: Habitrol OTC and Nicoderm CQ OTC)
- OTC nicotine gum (ex.: Nicorette gum OTC)
- OTC nicotine lozenges (ex.: Nicorette lozenge OTC and Nicorette mini lozenge OTC
Requirements for Coverage
- Member must be 18 years old
- Coverage for Chantix, prescription-only nicotine nasal spray or nicotine inhaler require members complete unsuccessful trial or experience an adverse reaction during the trial of both of the following products:
- Bupropion 150mg
- One of the available OTC nicotine replacement products (note: OTC nicotine trial must be documented in prescription history)
Length of Treatment
We will limit prescription fills for any of these products to a 30-day/one-month supply at a time. The maximum is 90 days/three months per approval. When appropriate, members can request reauthorization to continue treatment for an additional 90 days/three months of therapy. This cannot exceed two 90-day/three-month periods of smoking cessation therapy per 365 days/12 months.
Tobacco Cessation Counseling
Quit rates are highest when you pair tobacco cessation counseling and nicotine replacement therapies together. Our health coaches use motivational interviewing to help members decide when and how to quit. They will provide ongoing support to help members become tobacco free. Members with non-grandfathered plans can enroll by calling 855-838-5897, option 2. Members with ACA plans can enroll by calling 800-327-3183, ext. 25805.