Less than half of all ACA health plans offer all seven FDA-approved tobacco dependence treatment medications at no cost1
(New York, NY) – Tobacco use continues to be the single largest preventable cause of disease and premature death, killing more than 28,000 New Yorkers every year.2 Tobacco users not only have increased risk for multiple cancers; they also are more likely to suffer from heart disease, stroke, Chronic Obstructive Pulmonary Disease (COPD), and diabetes.3 Of the nearly 42 million current U.S. tobacco users, 42.7 percent report having made at least one quit attempt in the last year.4 As part of the Affordable Care Act (ACA), all health plans purchased through marketplaces are required to cover screening for tobacco use and tobacco cessation medications without prior authorization or associated cost-sharing. Based on guidance issued by the Centers for Medicare and Medicaid Services (CMS), this benefit includes coverage for all seven Food and Drug Administration (FDA)-approved tobacco dependence treatment medications.
A new report from the American Lung Association shows that health plans are falling short in this effort, with only 17 percent of all health insurance plans offering all seven FDA-approved tobacco dependence medications on their formularies.1 In New York State, only 11 percent, or two, plans covered all seven FDA-approved tobacco dependence treatment medications.
The Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York is building the capacity of ten Regional Contractors to work with federally qualified health centers (FQHC), mental health treatment facilities, and other health care organizations across New York State to implement health systems improvements that will ensure that every patient is screened for tobacco use, and that every tobacco user is offered and receives timely tobacco dependence treatment, if desired. The settings targeted by Regional Contractors serve populations for which tobacco use prevalence rates have not declined in recent years, specifically individuals with low-incomes, less than a high school diploma, and/or serious mental illness.
"Critical to a health system being able to successfully support a patient's quit attempt is the ability of the health care providers within it to tailor treatment plans to the needs of each individual patient," said Elizabeth Jones, Director, COE for HSI. "The evidence tells us that this entails being able to provide treatment that will maximize the likelihood that a quit attempt is successful."
Recent research shows that providing tobacco dependence treatment to those enrolled in the marketplace plans is especially important because tobacco use rates are higher among this population, which is made up of low-income populations and those previously uninsured.3
The full report from the American Lung Association is available at State Health Insurance Marketplace Plans: New Opportunities to Help Smokers Quit.
About CAI: CAI is a global nonprofit organization dedicated to improving the health and well-being of underserved populations worldwide. For 36 years CAI has provided customized capacity building services to health and human service organizations in over 27 countries and in all 50 states. Offering over 1,500 training programs annually, CAI's passionate staff works to fulfill its mission: to use the transformative power of education and research to foster a more aware, healthy, compassionate and equitable world. For more information about CAI, visit our website: www.caiglobal.org.
About the Center of Excellence for Health Systems Improvement: With funding from the New York State Department of Health Bureau of Tobacco Control, CAI serves as the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free NY. The COE for HSI promotes large-scale systems and policy changes to support the universal provision of evidence-based tobacco dependence treatment services. The COE for HSI aims to support 10 contractors throughout New York State working regionally with health care systems and organizations that serve those populations for which smoking prevalence rates have not decreased in recent years - adults with low income, less than a high school diploma and/or poor mental health. Focused on providing capacity building assistance services around topics like how to engage and obtain buy-in from leadership to implement the kinds of systems-level changes that will result in identification and intervention with every tobacco user who seeks care, the COE for HSI also will offer materials and resources to support contractors in their regional work. For more information, click here to visit the project website.
 American Lung Association. State Health Insurance Marketplace Plans: New Opportunities to Help Smokers Quit, 2015. Retrieved from http://www.lung.org/assets/documents/publications/other-reports/state-health-insurance-opportunities.pdf
 Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Retrieved from http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm?s_cid=cs_3281
 Centers for Disease Control and Prevention. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: Government Printing Office, 2010.
 Centers for Disease Control and Prevention. Smoking and Tobacco Use: Fast Facts. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/