State Tobacco Cessation Coverage

Medicaid Coverage

MassHealth covers:

NRT Gum
NRT Patch
NRT Nasal Spray
NRT Lozenge
NRT Inhaler

Varenicline (Chantix)
Bupropion (Zyban)
Group Counseling
Individual Counseling
Quitline

Co-payments of $1 are required for generic medications, and co-payments of $3 are required for brand name medications. Prior authorization is required for the NRT nasal spray and inhaler, and if the patient wants to extend treatment duration past 90 days (24 weeks for varenicline). Prior authorization is also required if number of quit attempts exceed 2 per year.

For more information, please call the MassHealth program at 617-573-1770, or visit their website at http://www.mass.gov/?pageID=eohhs2subtopic&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3=MassHealth&sid=Eeohhs2

View Medicaid Coverage Details

State Employee Health Plan Coverage

The Group Insurance Commission (GIC) covers:

NRT Gum
NRT Patch
NRT Nasal Spray
NRT Lozenge
NRT Inhaler
Varenicline (Chantix)

Bupropion (Zyban)
Group Counseling
Individual Counseling
Phone Counseling
Online Counseling

Members of the Fallon Community Health Plan may be able to receive counseling through their health plan. Please visit http://www.fchp.org/Extranet/Members/Wellness/Tobacco.htm for more information. Members of NHP can receive NRT patch, gum, lozenge, and inhaler, bupropion and varenicline through the Smoking Cessation Program. Requires contact with a Master Tobacco Treatment Specialist. For more information, visit http://www.nhp.org/SiteCollectionDocuments/PDF_Members/SmokingCessationMemberFactSheet.pdf.

For more information, please call the Massachusetts Group Insurance Commission at 617-727-2310, or visit their website at http://www.mass.gov/gic/gic.htm

View State Employee Health Plan Coverage Details

Private Insurance Coverage

This state does not require private health insurance plans to cover cessation treatments. Cessation coverage in private health insurance plans varies by employer and/or plan. Smokers with this type of health insurance should contact their insurance plan for information on cessation benefits.

This state does not mandate cessation coverage for private insurance plans.

Quitline

Contact Information: 1-800-QUIT-NOW; http://makesmokinghistory.org/1-800-quitnow.html

Hours: 9 AM - 7 PM Monday-Thursday; 9 AM - 5 PM Friday; 8 AM - 6 PM Saturday; 8 AM - 8 PM Sunday

Eligibility to recieve counseling: Age; Readiness

Medications provided:

NRT Gum
NRT Patch
NRT Nasal Spray
NRT Lozenge

NRT Inhaler
Varenicline (Chantix)
Bupropion (Zyban)

(Source: North American Quitline Consortium, www.naquitline.org)

American Lung Association Resources

The American Lung Association's Freedom from Smoking® program is widely available is community locations throughout the state of Massachusetts. Not On Tobacco is also offered in select locations. Additional options include Freedom From Smoking® Online, a program available 24/7 at http://www.ffsonline.org and the American Lung Association's Lung HelpLine (800-LUNG-USA). For further information, please call 781-890-4262 or visit us online at http://www.lung.org.

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?	No
Program Structure
NRT Gum	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, 'MassHealth Tobacco Cessation Benefits'
NRT Patch	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, 'MassHealth Tobacco Cessation Benefits'
NRT Nasal Spray	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, MassHealth Drug List, Table 6: Smoking Cessation
NRT Lozenge	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, 'MassHealth Tobacco Cessation Benefits'
NRT Inhaler	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, MassHealth Drug List, Table 6: Smoking Cessation
Varenicline (Chantix)	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, 'MassHealth Tobacco Cessation Benefits'
Bupropion (Zyban)	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, 'MassHealth Tobacco Cessation Benefits'
Group Counseling	Yes	MassHealth. 'How Do I Use My Benefits?'
Individual Counseling	Yes	MassHealth. 'How Do I Use My Benefits?'
Quitline	Yes

Type of Barrier	State Has Barrier?	Data Source
Counseling Required for Medications	No
Prior authorization required	Yes	Commonwealth of Massachusetts, Office of Health and Human Services, MassHealth Drug List, Table 6: Smoking Cessation
Lifetime limit on quit attempts	No
Stepped-care therapy	No
Annual limit on quit attempts	Yes	Code of Massachusetts Regulations, 130.CMR410.420
Limits on duration	No	Code of Massachusetts Regulations, 130.CMR410.420
Co-payments required	Yes	Code of Massachusetts Regulations, Title 130, Chapter 450.000
Dollar Limit	No
Other

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?	Yes
Structure of Program
NRT Gum	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
NRT Patch	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
NRT Nasal Spray	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
NRT Lozenge	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
NRT Inhaler	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Varenicline (Chantix)	Yes	Correspondence with the Massachusetts Department of Health. October 2012.
Bupropion (Zyban)	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Group Counseling	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Individual Counseling	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Phone Counseling	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Online Counseling	No

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Lifetime limit on quit attempts	No	Correspondence with the Massachusetts Department of Health. October 2012.
Annual limit on quit attempts	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Prior authorization required	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Co-payments required	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Stepped-care therapy	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Counseling Required for Medications	Varies	Correspondence with the Massachusetts Department of Health. October 2012.
Dollar Limit	Varies	Correspondence with the Massachusetts Department of Health. October 2012.

Type	Value	Data Source
Mandate applies to all populations	Not Applicable
Mandate applies to all insurance carriers	Not Applicable
Cessation mandate on the books	No
Other stipulations	Not Applicable
State mandates wellness program including smoking cessation	No

Stop Smoking

Lung HelpLine

E-Newsletter

Massachusetts

Medicaid Coverage

State Employee Health Plan Coverage

Private Insurance Coverage

Quitline

American Lung Association Resources

Medicaid Data Sources

State Employee Health Plan Data Sources

Private Insurance Coverage Details