Section I: Funding Tobacco Cessation Programs
The U.S. Office of Personnel Management supports and encourages agency authorized programs aimed at health promotion and disease prevention, including smoking cessation programs. In 2003, OPM initiated "HealthierFeds" (www.opm.gov/healthierfeds/) as part of the broader Presidential initiative, "HealthierUS." One of the chief aims of the initiative is to encourage Federal employees to make healthier lifestyle choices, including the cessation of tobacco use.
According to reports issued by the Surgeon General, smoking is the chief avoidable cause of death in our society. Programs designed to help employees stop using tobacco are not only in the best health interests of those Federal employees who are tobacco users, data from the Centers for Disease Control and Prevention (CDC) indicate that tobacco cessation may also contribute to improved organizational performance and productivity.
The purpose of these guidelines is to assist agencies in the development of tobacco cessation programs, including those which provide, as one element, pharmacotherapy (such as a nicotine replacement therapy (NRT), i.e., the nicotine patch or nicotine gum).
A decision by the Comptroller General of the United States (B-231543 dated February 3, 1989) held that under 5 U.S.C. § 7901, Federal agencies have the authority to utilize appropriated funds to pay the costs incurred by employees participating in agency-sponsored smoking cessation programs. The decision held that because smoking is a major contributing cause of illnesses such as cancer, coronary disease and emphysema, smoking cessation programs are "preventive" in nature and authorized under 5 USC § 7901(c)(4).
Agencies may wish to develop their own in-house programs or contract with program providers (see section II, A Checklist for Assessing a Group Cessation Program ). Such programs usually include: (1) educational materials; (2) classroom training; (3) individual and/or group counseling; and/or (4) pharmacologic therapy (such as nicotine replacement therapy).
Since appropriated funds may be used to pay for the provision of pharmacologic treatment and the costs of over-the-counter nicotine replacement therapy (such as the nicotine patch or nicotine gum), the following guidance is provided to assist program administrators:
Agency Purchase: Agencies that desire to provide their employees with nicotine replacement therapies, as part of an agency's smoking cessation program, should acquire those items in accordance with the regulatory and statutory provisions contained in the Federal Acquisition Regulation and all internal agency guidelines for the expenditure of appropriated funds. Agencies may also wish to contract with tobacco cessation program providers which include, as part of their program, nicotine replacement therapy.
Agencies may also purchase nicotine replacement therapy for employees who wish to quit using tobacco but who do not wish to attend formal classroom sessions sponsored by the agency. In this instance, agencies should offer employees on-site or telephone counseling services. Such counseling services, however, should not be made mandatory. Employees requesting agency purchase of nicotine replacement therapy in such circumstances should be considered as participating in the agency's smoking cessation program.
Employee Requests: When requesting the agency purchases a nicotine replacement therapy, as part of an agency's program, employees should provide program administrators (e.g., health unit physician, nurse, or Employee Assistance Program counselor) with a written request. Such a request would be appropriate regardless of whether the employee is participating in an on-site classroom program or in a self-initiated process.
The following information is provided for the benefit of employees who elect to participate in tobacco cessation programs other than agency-sponsored programs on-site. While agencies would not pay for the cost of registration for such programs, employees should be aware that they can seek insurance plan reimbursement (up to the amount covered in their health benefits plan). In these instances, however, employees may request agency purchase of pharmacologic treatment such as nicotine replacement therapy if such therapy were in addition to the program registration cost. These employees would be considered as participating in the agency's program.
Under the Federal Employee Health Benefits (FEHB) programs, a number of insurance plans cover some costs associated with smoking cessation. Federal employees need to refer to their plan brochure for specific coverage information (by reviewing your plan's coverage at www.opm.gov/insure/health/index.asp and then clicking on "current plan brochures").
FEHB carriers are encouraged to provide benefits for smoking cessation that follow the Public Health Service's treatment guidelines. Consistent with these guidelines, primary care visits for tobacco cessation should be covered with the standard office visit co-payment. Individual or group counseling for tobacco cessation should be covered with no co-payment. Prescriptions for all Food and Drug Administration–approved medications for treatment of tobacco use should be covered with the usual pharmacy co-payments.
Benefits vary by carrier. For example, a carrier might offer coverage for smoking cessation programs for either $100 lifetime maximum benefit per member or one course of treatment per member per calendar year. The Prescription Drugs Benefits section of each plan's brochure specifies whether drugs to aid in smoking cessation are covered or excluded.