Medicaid Coverage

The New Jersey Medicaid program covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • variesIndividual Counseling
  • noQuitline

All seven pharmacotherapies and medications are covered. Individual and group counseling coverage varies by plan. Coverage limitations, including those on duration and the number of quit attempts per year that are covered, varies by plan. Prior authorization and step therapy is required for some plans.

For more information, please call the Division of Medical Assistance and Health Services at 800-356-1561, or visit their website at http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

Note: the Affordable Care Act requires all Medicaid programs cover all tobacco cessation medications beginning January 1, 2014. If a medication is marked here as not being covered, there is not yet evidence that Medicaid has complied with this requirement. Patients should call their Medicaid program and ask how to receive these medications.

Health Insurance Marketplace Coverage

All plans in the Health Insurance Marketplace are required to cover tobacco cessation treatment. Specific coverage varies by plan. Check with your insurance plan to find out what is covered.

State Employee Health Plan Coverage

The State Health Benefits Program covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • variesIndividual Counseling
  • noPhone Counseling
  • yesNo Tobacco Surcharge

All seven pharmacotherapies and medications are covered. Individual and group counseling coverage varies by plan. Duration limits limiting the number of counseling sessions also vary by plan.

For more information, please call the Division of Pensions and Benefits at 609-292-7524, or visit their website at http://www.state.nj.us/treasury/pensions/health-benefits.shtml

Private Insurance Coverage

All private health insurance plans in New Jersey must cover an annual 'wellness' appointment with members' primary care physician to discuss smoking cessation (if applicable, among other things). If the physician determines that cessation treatment is medically appropriate, treatment is required to be covered up to a certain dollar amount: $125 for ages 20-39; $145 for men over age 40; $235 for women over age 40. This requirement applies to all plan members age 20 and over. For more information about how this requirement affects you, please contact your health plan.

Quitline

Contact Information: 1-866-657-8677; http://www.njquitline.org/

Hours: 8:00 AM - 3:00 AM Monday-Sunday

Eligibility to recieve counseling: Resident of NJ, 18 years, readiness to quit - set quit date within 30 days, must be registered for Medicaid or currently uninsured. For medication: age 18+; NJ resident; 10 cig/day or more; plan to quit within 30 days or recently quit smoker currently using NRT for up to 30 days or recently quit smokers up to 2 weeks and not using NRT; no contraindications; agree to quit date callback-while supples last.

Medications provided:

  • noNicotine Gum
  • noNicotine Patch
  • noNicotine Nasal Spray
  • noNicotine Lozenge
  • noNicotine Inhaler
  • noVarenicline (Chantix)
  • noBupropion (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 in community locations throughout New Jersey. In addition, Not On Tobacco is offered in select high schools. 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 more information about program locations and schedules, call 1-800-LUNGUSA, or visit http://www.lunginfo.org.