New York and Oklahoma Make it Easier for Persons with Behavior Health Conditions to Access Non-Nicotine Cessation Medications

Behavioral health facilities in New York and Oklahoma are national leaders in providing non-nicotine medications to help persons receiving treatment for mental or substance use disorders quit using tobacco.

Medicaid pays for mental health treatment for more persons in the U.S. than any other insurer, and its role in paying for substance use disorder treatment is growing.¹ State Medicaid programs are required to cover all seven medications, including two non-nicotine medications—varenicline and buproprion—approved by the Food and Drug Administration for smoking cessation.^{2, 3} As of June 30, 2017, 32 states covered all seven of these medications for all traditional (non-expansion) Medicaid enrollees.⁴ However, barriers such as copayments, prior authorization, limits on the number of treatments allowed per year, or limits on how long treatment can be provided, may make it difficult for Medicaid enrollees to obtain these medications.⁴

New York’s Medicaid program pays for non-nicotine cessation medications.⁵ Because most people who smoke make multiple quit attempts before succeeding, New York does not cap the number of times each year it will pay for the medication for a client insured through Medicaid.⁵ This may be especially beneficial for behavioral health clients who smoke as they tend to be heavier smokers and may need extra help following medication regimens.⁶ With funding from New York’s Bureau of Tobacco Control to promote universal provision of tobacco dependence treatment services, the Center of Excellence for Health Systems Improvement:

• Gathered information from the state Bureau of Tobacco Control, the Office of Alcoholism and Substance Abuse Services, and the Office of Mental Health,
• Outlined what each behavioral health regulatory body requires and recommends for providing tobacco cessation medication,⁷ and
• Drafted a Tobacco Dependence Treatment Financial Modeling Tool that, once finalized, will be piloted by Department of Health grantees assisting health care organizations. The Tool is intended to help the health care organizations better understand the costs and benefits of taking a range of steps to help people who smoke quit, including providing cessation medications on-site.⁸

Similarly, Oklahoma’s Medicaid program pays for non-nicotine cessation medications.⁹ It does not limit the number of times each year a client insured through Medicaid can access bupropion, one of the two non-nicotine medications approved by the FDA for tobacco cessation.¹⁰ The changes that were made to Oklahoma’s Medicaid program to provide this coverage stemmed from a partnership between the Oklahoma Health Care Authority, the Oklahoma Tobacco Settlement Endowment Trust, and the Oklahoma State Department of Health. The group:

• Identified who was responsible for policy change,
• Gathered data about the costs of providing cessation medications, the number of people who would seek the medications, and the number of people who likely would quit using tobacco, and
• Showed what the return on investment would be if cessation medications were covered by Medicaid at no cost to the client.¹¹

The proportion of Oklahoma mental health treatment facilities and the proportion of New York mental and substance use disorder treatment facilities providing non-nicotine medications to clients is nearly double the proportion of behavioral health treatment facilities doing so elsewhere in the U.S.⁶

1. Centers for Medicare and Medicaid Services. Medicaid Benefits: Behavioral Health Servicesexternal icon. Accessed December 10, 2019.
2. American Lung Association. Tobacco Cessation Treatment: What is Covered?external icon Accessed December 10, 2019.
3. Centers for Medicare and Medicaid Services. State Medicaid Director Letter, SDL # 11-007. 2011 pdf icon[PDF – 273 KB]external icon.
4. DiGiulio A, Jump Z, Yu A, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments – United States, 2015-2017. Morbidity and Mortality Weekly Report, 67(13):390—395, 2018.
5. New York Department of Health.  Get Help Quittingexternal icon. Accessed December 10, 2019.
6. Marynak K, VanFrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 67(18):519—523, 2018.
7. Center of Excellence for Health Systems Improvement. Behavioral Health Tobacco Dependence Regulation Crosswalk. pdf icon[PDF – 1 MB]external icon Accessed December 10, 2019.
8. Center of Excellence for Health Systems Improvement. Tobacco Dependence Treatment Financial Modeling Tool. pdf icon[PDF – 850 KB]external icon Accessed December 10, 2019.
9. Oklahoma Health Care Authority. Thinking About Quitting Smoking?external icon Accessed December 10, 2019.
10. Oklahoma Health Care Authority. SoonerCare Tobacco Cessation Benefit.external icon Accessed December 10, 2019.
11. For more information about Oklahoma’s work to expand Medicaid coverage for tobacco cessation treatment, see American Lung Association. Medicaid Tobacco Cessation Coverage in Oklahoma: A Case Study in Leveraging Systems and Partnerships. pdf icon[PDF – 2 MB] Note that this case study indicated that there were limits on the amount of medications Medicaid enrollees could access each year, and that the partnership was working on removing those caps on all FDA-approved cessation medications, except varenicline. Since the case study was written, the partnership achieved this goal.