May. 2 2014
WASHINGTON – The Obama Administration today has taken a much-needed step to help smokers and other tobacco users quit by making clear the minimum, evidence-based tobacco cessation services that health insurers are required to cover under the Affordable Care Act (ACA).
Today the Administration posted, in a Frequently Asked Questions format, a clear statement that tells insurers they must cover, without cost-sharing, screening for tobacco use and tobacco cessation services for those who use tobacco products that includes at least two cessation attempts per year. The Administration stated that coverage should include four tobacco counseling sessions of at least 10 minutes each (including telephone, group and/or individual counseling) and all Food and Drug Administration-approved tobacco cessation medications, including both prescription and over-the-counter (OTC) medications.
This direction to insurers is an essential step toward fulfilling the promise of the law to help more tobacco users quit. It establishes a minimum standard for what insurers must cover and provides tobacco users with an important tool to help them get the required coverage and treatment. It is critical that the Department of Health and Human Services and other federal departments effectively enforce this standard and ensure that insurers provide the necessary coverage, especially given the evidence that many so far have failed to do so.
The ACA requires all new private health insurance plans to cover preventive health services recommended with an A or B grade by the U.S. Preventive Services Task Force, with no cost-sharing such as co-pays. Tobacco cessation treatments received an A grade, with the task force finding that a combination of medication and counseling is most effect at helping tobacco users quit.
However, evidence indicates that many health plans are not covering the cessation services that have been proven to help tobacco users quit. Both this year’s Surgeon General’s report on smoking and a 2012 report by Georgetown University researchers found that tobacco cessation treatment coverage mandated by the ACA varies significantly across private health insurance contracts. The document issued today will help ensure that tobacco users have evidence-based coverage for cost-free medication and counseling that can help them quit successfully and that is required by the law.
The new Surgeon General’s report released in January (The Health Consequences of Smoking — 50 Years of Progress) underscored the importance of doing more to help tobacco users quit. The report found that smoking is even more hazardous and takes an even greater toll on the nation’s health than previously reported. It found that smoking annually kills 480,000 Americans – causing about one in every five deaths — and costs at least $289 billion in medical bills and other economic losses. As the Surgeon General’s report notes, in 2011 nearly 70 percent of adult smokers indicated they wanted to stop smoking and 43 percent had made a quite attempt.
Noting that the "current rate of progress in tobacco control is not fast enough," the report calls for a number of specific actions, including "fulfilling the opportunity of the Affordable Care Act to provide access to barrier-free proven tobacco use cessation treatment including counseling and medication to all smokers."
A 2012 study conducted for the Campaign for Tobacco-Free Kids by Georgetown University’s Health Policy Institute found that many health insurance plans were failing to provide the coverage mandated by the ACA for treatments to help tobacco users quit. Specifically, researchers found that only four of the 39 private plans analyzed clearly covered a full-range of evidence-based tobacco cessation services (i.e., individual, group and phone counseling and both prescription and over-the-counter tobacco cessation medications). Contract language for these plans often contained vague or conflicting language that made it impossible to determine which, if any, tobacco cessation services were covered. When the extent of coverage could be determined, many of these plans excluded coverage of prescription and/or OTC medications for tobacco cessation and excluded certain types of counseling. Also troubling, some of the plans analyzed impose cost-sharing requirements for tobacco cessation treatments.
The results of this study prompted the Campaign for Tobacco-Free Kids and other public health groups to call on federal officials to clarify to insurers that the full range of cessation services should be covered without cost sharing. By doing so today, the Administration will help more smokers quit, saving lives and health care dollars.