Helping Smokers on Medicaid Quit September 16, 2014 Paul G. Billings Senior VP, Advocacy &...
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Transcript of Helping Smokers on Medicaid Quit September 16, 2014 Paul G. Billings Senior VP, Advocacy &...
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Helping Smokers on Medicaid QuitSeptember 16, 2014
Paul G. BillingsSenior VP, Advocacy & Education
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Questions to Answer
• Why?• What is a comprehensive cessation benefit?• How has ACA changed things?• What are states doing?• What should my state do?
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Background
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Toll of Tobacco• 43.6 million Americans smoke • 273 billion cigarettes sold• 480,000 premature deaths• $333 billion in annual health costs• 5.6 million of today’s children under age 18 will
die prematurely
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Quit Attempts
• The American Lung Association conducted research to better understand motivators to quit smoking and the number of attempts it typically takes American adults to quit.
• The survey found that 6 out of 10 former smokers were not able to successfully quit on their first try and required multiple attempts to quit smoking for good.
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Why Help Smokers on Medicaid Quit?
People on Medicaid smoke at higher rates than the general population
Smoking Rate of Population Ages 18-65, 2012
National Health Interview Survey, 2012. Data analyzed by American Lung Association
General Population
Enrolled in Medicaid
Uninsured
18.1 percent 30.1 percent 29.6 percent
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• Low-income Medicaid beneficiaries are less able to pay for treatments on their own
• Other factors that make it harder to access treatment:
Why Help Smokers on Medicaid Quit?
• Lack of extra time• Lack of transportation• Shortage of doctors that take
Medicaid• Other complicating health
factors• Low literacy levels/English as a
second language
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Helping smokers on Medicaid quit saves lives
Why Help Smokers on Medicaid Quit?
Short-Term Reductions•Pregnancy & childbirth complications (low birth weight, SIDS)•Heart attacks•Asthma attacks•ER visits
Long-Term Reductions•Lung cancer•COPD•Heart Disease•Other cancers
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Helping smokers on Medicaid quit saves money
–Smoking-related disease costs Medicaid programs an average of $833 million per state per year–Return-on-investment as high as 3-to-1 has been shown
Why Help Smokers on Medicaid Quit?
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Massachusetts
• Implemented a model benefit in 2006
• Within the first two years:– 40 percent (75,000 people)
Medicaid enrollees used the benefit
– 26 percent reduction in Medicaid smoking rate
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Massachusetts
Cost savings:•Risk of heart attack hospitalizations dropped 46 percent•Risk of hospitalization for other acute coronary heart disease diagnoses dropped 49 percent•For every dollar spent on the benefit, the state saved $3
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Comprehensive Benefit
• 7 medications– 5 NRTs– Bupropion– Varenicline
• 3 types of counseling– Individual (face-to-face)– Group– Phone
• Easy to access/no limits
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Barriers to Access
• Cost-sharing• Prior authorization• Duration limits• Yearly or lifetime limits• Dollar limits• Stepped care therapy• Required counseling
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Affordable Care Act
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Traditional Medicaid – Tobacco Cessation
• September 2010: comprehensive tobacco cessation benefit required for pregnant women with no cost sharing
• January 1, 2014: States are no longer able to exclude tobacco cessation medications– What will this mean in implementation?– Watch barriers, preferred drug
lists/formularies
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Requirements for Medicaid Expansion
Plans offered to expansion population must cover the Essential Health Benefit
Preventive services with no cost-sharing
Tobacco Cessation FAQ Guidance
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Tobacco Cessation FAQ*
• 4 sessions of individual, group and phone counseling
• 90 days of 1 of the FDA-approved smoking cessation medications, when proscribed
• No cost-sharing• No prior authorization• At least 2 quit attempts per year
* HHS, Labor and Treasury
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What are States Doing?
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Barriers-Traditional Medicaid
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What Should My State Do?
• Cover all treatments• Remove as many barriers as possible
– Copays!
• Promote cessation benefits and encourage smoking cessation
• Adequately fund state quitline
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Resources
Toolkit on Cessation Coverage:
www.lung.org/acatoolkit
– Helping Smokers Quit – state by state information– Factsheets– Additional Resources