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• Coverage for…Cessation Treatments

Coverage for Tobacco Use Cessation Treatments

Benefits Summary

Why Is Health Insurance Coverage for Tobacco Use Treatments So Important?

• Smoking is costly to employers both in terms of smoking-related medical expenses and lost productivity.
  • Ten percent of smokers alive today are living with a smoking-related illness.¹
  • Men who smoke incur $15,800² (in 2002 dollars) more in lifetime medical expenses and are absent from work 4 days more per year than men who do not smoke.³
  • Women who smoke incur $17,500² (in 2002 dollars) more in lifetime medical expenses and are absent from work 2 days more each year than nonsmoking women.³
  • In 1999, each adult smoker cost employers $1,760 in lost productivity and $1,623 in excess medical expenditures.⁴
  • Smoking causes heart disease, stroke, multiple cancers, respiratory diseases, and other costly illnesses. Secondhand smoke causes lung disease and lung cancer.^5,6
  • Smoking increases costly complications of pregnancy, such as pre-term delivery and low birth-weight infants.⁷
• Smoking is the leading preventable cause of death in the United States.^8,9 Smokers who quit will, on average, live longer and have fewer years living with disability.¹⁰
• About 23% of American adults and 28% of teens smoke.^11,12 More than 70% want to quit, but few succeed without help.¹¹ Tobacco use treatment doubles quitting success rates.⁹

Paying for tobacco use cessation treatments is the single most cost-effective health insurance benefit for adults that can be provided to employees.^13,14,15

What Treatments Are Available? How Effective Are They?

Smoking cessation treatments have been found to be safe and effective. These include counseling and medications, or a combination of both.⁹

• Face-to-face counseling and interactive telephone counseling are more effective than services that only provide educational or self-help materials.^9,16
• The effectiveness of counseling services increases as their intensity (the number and length of sessions) increases.⁹
• Smokers are more likely to use telephone counseling than to participate in individual or group counseling sessions.^16,17
• The Food and Drug Administration has approved six first-line medications to help smokers quit:
  • Five are nicotine replacement therapies that relieve withdrawal symptoms. They include nicotine gum, patch, nasal spray, inhaler, and lozenge.⁹
  • The sixth medication, bupropion SR (sustained release), is a non-nicotine medication that is thought to reduce the urge to smoke by affecting the same chemical messengers in the brain that are affected by nicotine.⁹

* Approved by the Food and Drug Administration (FDA) and addressed in the 2000 PHS Guidelines.
** Received FDA approval on October 31, 2002, therefore not addressed in the 2000 PHS Guidelines.

Scientifically proven treatments can double a person's chances of quitting smoking.⁹

How Should Benefits Be Designed?

Benefits for proven tobacco-use cessation treatments have been shown to increase treatment use and the number of successful quitters; therefore, both the Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence, and the Community Preventive Services Task Force recommend that all insurers provide tobacco cessation benefits that do the following:

• Cover at least four counseling sessions of at least 30 minutes each,⁹ including proactive telephone counseling and individual counseling. While classes are also effective, few smokers attend them.¹⁹
  • Ten percent of smokers alive today are living with a smoking-related illness.¹
  • Cover both prescription and over-the-counter nicotine replacement medication and bupropion (see medication table).⁹
  • Provide counseling and medication coverage for at least two smoking cessation attempts per year.^20,21
  • Eliminate or minimize co-pays or deductibles for counseling and medications, as even small copayments reduce the use of proven treatments.^18,19

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