1. Helping Smokers on Medicaid Quit September 16, 2014 Paul G. Billings Senior VP, Advocacy & Education

2. Questions to Answer Why? What is a comprehensive cessation benefit? How has ACA changed things? What are states doing? What should my state do?

3. Background

5. 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

6. 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.

8. 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 percent30.1 percent29.6 percent

9. 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

10. 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

11. 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?

12. 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

13. 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

14. Comprehensive Benefit 7 medications –5 NRTs –Bupropion –Varenicline 3 types of counseling –Individual (face-to-face) –Group –Phone Easy to access/no limits

15. Barriers to Access Cost-sharing Prior authorization Duration limits Yearly or lifetime limits Dollar limits Stepped care therapy Required counseling

16. Affordable Care Act

17. 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

18. 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

19. 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

20. What are States Doing?

21. Barriers-Traditional Medicaid

23. 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

24. Resources Toolkit on Cessation Coverage: www.lung.org/acatoolkit –Helping Smokers Quit – state by state information –Factsheets –Additional Resources