Smokers in Medicaid Rarely Accessed Cessation Medication, Counseling

Medicaid fee-for-service beneficiaries who tried to quit smoking cigarettes rarely accessed cessation medication or counseling despite the wide range of cessation treatments that Medicaid covers, a study published in Nicotine & Tobacco Research found.

Individuals enrolled in Medicaid are more likely to smoke cigarettes than individuals with private health insurance. Smoking cessation treatments, such as counseling and seven FDA-approved medications, can help individuals quit smoking and reduce smoking-related morbidity and mortality.

To understand how often Medicaid fee-for-service beneficiaries utilized cessation treatment and the spending associated with it, researchers gathered Medicaid claims data from the Medicaid Analytic eXtract (MAX) files from 2010 to 2014.

They used the most recent data for each state and the District of Columbia, including data from 2014 for 17 states, 2013 for 11 states, 2012 for 20 states, 2011 for two states, and data from 2010 for one state. They estimated the number of beneficiaries who tried to quit smoking using the Behavioral Risk Factor Surveillance System data.

Thirty-seven states reported cessation medication claims for Medicare fee-for-service beneficiaries. Among these states, 24 offered Medicaid coverage for all seven medications.

Only 9.4 percent of Medicaid beneficiaries who attempted to quit smoking accessed cessation medication. Certain states saw higher rates than others. For example, only 0.2 percent of individuals in Arkansas had a cessation medication claim, while 32.9 percent accessed medication in Minnesota. Just 13 states saw rates of 10 percent or higher.

There was an average of 21.5 prescriptions per 100 Medicaid fee-for-service beneficiaries who tried to quit smoking, the study found. The number of prescriptions ranged from 0.5 per 100 beneficiaries in Arkansas to 89.2 per 100 beneficiaries in Minnesota. The average number of cessation medication claims per user was 2.5.

Even fewer Medicaid fee-for-service beneficiaries who had a past-year attempt to quit smoking received cessation counseling services. Only 2.6 percent of beneficiaries on average had a claim for cessation counseling, ranging from 0.1 percent in Florida to 5.6 percent in Missouri, the study revealed.

There was an average rate of 4.3 counseling services per 100 beneficiaries who tried to quit smoking.

The researchers found that if all Medicare fee-for-service beneficiaries who had a past-year quit attempt sought and received cessation treatment, the total Medicaid spending would only be a sliver of what Medicaid spends annually on treating smoking-related diseases.

Total spending for cessation medication among Medicaid beneficiaries was around $12.9 million, according to the study. Total Medicaid spending for cessation counseling was $342,008.

If all Medicaid fee-for-service smokers who tried to quit accessed cessation medication, the projected total spending would be $127.1 million. After including Medicaid managed care beneficiaries, the project spending would be $841.1 million—1.7 percent of the $45.9 billion Medicaid spends per year to treat smoking-related diseases.

The total projected spending for cessation medication was less than 0.2 percent of Medicaid’s total expenditure per year.

The prevalence of cessation treatment claims varied across states. This could be due to differences in state Medicaid coverage, promotion efforts, and variations in the extent that healthcare providers prescribed medications or suggested counseling services to Medicaid beneficiaries.

In 2014, the Affordable Care Act introduced a policy that requires all state Medicaid programs to offer coverage for FDA-approved cessation medications.

The study results suggested that Medicaid programs and healthcare professionals should increase the promotion of cessation services, as counseling and medication can lead individuals to quit smoking and see better health outcomes.

“Covering these treatments with minimal barriers and promoting this coverage so that Medicaid smokers and their providers are aware of and use the covered treatments are essential,” the study concluded.

“Continued monitoring of Medicaid enrollees’ use of cessation treatments is vital to track progress in quitting smoking in this vulnerable population.”