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Reform Update: Some states begin implementing ACA's Medicaid stop-smoking provisions


By Virgil Dickson
Posted: June 10, 2014 - 4:15 pm ET
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North Carolina has become the latest state to formally implement a provision (PDF) of the healthcare reform law requiring state Medicaid programs to cover drugs used for smoking cessation both in their traditional and managed-care programs.

A number of states still haven't formally adopted the provision in their state Medicaid plans. But Medicaid officials in most states say they support the coverage provision and were already covering the drugs.

Still, experts say coverage of smoking cessation drugs may not do much to reduce the high incidence of smoking among Medicaid beneficiaries.

Over the last two months, the CMS has approved Medicaid plan amendments from Colorado, Kansas, North Carolina, North Dakota, Oregon and several other states to comply with the ACA coverage requirement for these drugs. Both Republican- and Democratic-led states say they support the provision and expect that it will have little if any impact on Medicaid spending.

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Under the ACA, state Medicaid programs are required to cover drugs used for smoking cessation including Chantix, one of the most commonly used drugs. The provision applies to all states, whether they expanded Medicaid or not. That requirement took effect Jan. 1 of this year. Prior to the healthcare reform law, states had the option to exclude coverage of these drugs, or pick and choose which smoking cessation drugs their Medicaid program would cover.

In 2010, 36.5% of the more than 58 million people enrolled in Medicaid smoked, significantly higher than the 22.7% of the general population that smoked, according to the American Lung Association.

A guidance on the new drug coverage requirement was published by the CMS late last year (PDF), and Medicaid agencies were asked to submit amendments to their state's coverage plans to indicate compliance with the law. The document did not however give states a specific deadline for submitting these amendments or a timeline for CMS approval of these amendments.

Medicaid managed-care insurers also are generally supportive of this requirement. “The costs associated with treatment is nominal compared to treating smoking-related conditions,” said Sarah Dykstra, a clinical pharmacist at iCare, a Wisconsin-based insurance plan co-owned by Humana.

Healthcare providers also favor the provision, given the key role tobacco cessation plays in preventing such diseases as hypertension, chronic obstructive pulmonary disease, emphysema, stroke and cancer. “Considering that this patient population has a tendency to utilize tobacco to a greater extent, it is possible that this step could prevent disease,” said Yen Pham, director of pharmacy services at the Oregon Health & Science University.

As of Jan. 31 of this year, only seven state Medicaid programs covered all seven Food and Drug Administration-approved tobacco cessation drugs and counseling, according to the American Lung Association.

But the association said there has been progress, with five states going from covering no treatments to covering multiple treatments, and 33 states in the past five years adding tobacco cessation benefits for at least some Medicaid beneficiaries.

On the other hand, the group said, 29 states added policies over the past five years making it harder to access stop-smoking treatment, including prior authorization, limits on the number of times smokers can try to quit with treatment and copayments.

David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, said he doubts whether the expansion of Medicaid coverage for smoking-cessation drugs will lead to a significant cut in smoking rates without additional services such as counseling.

A recent study in the American Journal of Preventive Medicine (PDF) found that comprehensive tobacco dependence treatment including pharmaco-therapy and counseling is associated with a greater likelihood of Medicaid recipients quitting smoking than pharmaco-therapy coverage alone.

Expanded Medicaid coverage of smoking cessation drugs “is an important step forward in expanding access to evidence-based cessation treatments for a vulnerable population with high smoking rates,” said Dr. Tim McAfee, director of the Center for Disease Control and Prevention's Office on Smoking and Health.

He said other important steps include removing barriers to stop-smoking treatments such as co-payments and prior authorization, and promoting the new drug coverage to ensure that smokers and their providers are aware of it.

Hope for Medicaid expansion in Virginia dashed by lawmaker's exit

Attempts by Virginia's Democratic Gov. Terry McAuliffe to expand Medicaid in his state may be thwarted for now, following the resignation of state Sen. Phillip Puckett, a fellow Democrat. His departure gives Republicans a one-vote majority in the chamber.

With the state's House also GOP-controlled, expanding Medicaid to as many as 400,000 Virginians under the Patient Protection and Affordable Care Act may not be possible.

Puckett cited family issues as the reason for his departure, denying allegations that he had essentially been bought off by Republicans with a potential position on the Republican-controlled Virginia Tobacco Commission, according to a statement from him posted by The Washington Post.

McAuliffe insists he will fight on by continuing to work with the Senate on a budget that would include expansion.

Trade group asks OMB to determine Sovaldi’s cost

Medicaid Health Plans of America, a national trade group, has sent a letter to the Office of Management and Budget asking it to assess the cost of the hepatitis C virus treatment Sovaldi for the federal government in its mid-session review of President Barack Obama’s fiscal 2014 budget.

The drug’s pricing of nearly $85,000 for a standard 12-week treatment is expected to add cost pressure to already stressed federal programs, the group argues.

As a result, the trade group says taxpayers and Congress should be provided with clear and transparent information on the size and scope of Sovaldi’s cost to federal programs.

Follow Virgil Dickson on Twitter: @MHvdickson


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