State Tobacco Cessation Coverage

Medicaid Coverage

The New York Medicaid program covers:

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

Bupropion (Zyban)
Group Counseling
Individual Counseling

Medications are limited to 90 days per course of treatment and two quit attempts per year. Co-payments may be required, depending on health plan. Counseling is provided for pregnant and post-pardum women, and children ages 10-21 only.

For more information, please visit the website of the New York State Department of Health at http://www.health.state.ny.us/health_care/medicaid/

View Medicaid Coverage Details

State Employee Health Plan Coverage

The New York State Health Insurance Program (NYSHIP) covers:

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

Bupropion (Zyban)
Group Counseling
Individual Counseling
Phone Counseling

Coverage varies by health plan. Please contact your health plan directly for information about cessation coverage provided to you.

For more information, please call the New York State Health Insurance Plan at 518-457-2487 or 877-697-5627, or visit their website at http://www.cs.state.ny.us/ebd/welcome/login.cfm

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

The New York State Smokers' Quitline is open 9AM-9PM (M-F), 9AM-1PM (SAT-SUN) (Eastern Time). You can reach the New York State Smokers' Quitline by calling 866-NY-QUITS.

American Lung Association Resources

The American Lung Association of New York provides smoking cessation services statewide. 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 631-265-3848 or visit us online at http://www.alany.org

Medicaid Data Sources

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?	No
NRT Gum	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
NRT Patch	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
NRT Nasal Spray	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
NRT Lozenge	No	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
NRT Inhaler	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
Varenicline (Chantix)	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
Bupropion (Zyban)	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
Group Counseling	No	New York State Department of Health, Medicaid Update, Volume 25, Number 17, October 2009
Individual Counseling	Varies	New York State Department of Health, Medicaid Update, Volume 25, Number 17, December 2009

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
Lifetime limit on quit attempts	No
Annual limit on quit attempts	Yes	New York State, Department of Health, Medicaid Update, "Smoking Cessation Medication Coverage Policy for Medicaid", Volume 24, Number 11, October 2008
Prior authorization required	No
Co-payments required	Varies	New York State Department of Health, "What Health Services are Covered by Medicaid?"
Stepped-care therapy	No
Counseling Required for Medications	No
Dollar Limit	No
Other

Additional Data Sources
New York State, Medicaid Update, Volume 25, Number 4, "New York State Budget: Health Reform Highlights", April 2009
New York State, Department of Health, August 2006, "Smoking Cessation in New York State"
New York State, Department of Health, Medicaid in New York State, "What health services are covered by Medicaid?"
New York State, Department of Health, Medicaid Update, January 2006, vol. 21, no. 1, "Recipient Stop Smoking Coverage Fact Sheet"

State Employee Health Plan Data Sources

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?
NRT Gum	Varies	Multiple sources, varying by health plan. See Additional Sources below.
NRT Patch	Varies	Multiple sources, varying by health plan. See Additional Sources below.
NRT Nasal Spray	Varies	Multiple sources, varying by health plan. See Additional Sources below.
NRT Lozenge	Varies	Multiple sources, varying by health plan. See Additional Sources below.
NRT Inhaler	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Varenicline (Chantix)	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Bupropion (Zyban)	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Group Counseling	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Individual Counseling	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Phone Counseling	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Online Counseling	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Quit Kit	No

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Lifetime limit on quit attempts	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Annual limit on quit attempts	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Prior authorization required	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Co-payments required	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Stepped-care therapy	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Counseling Required for Medications	Varies	Multiple sources, varying by health plan. See Additional Sources below.
Dollar Limit	No

Additional Data Sources
CDPHP, Wellness Education, Classes and Programs
CDPHP, Clinical Formulary 2008
Aetna, 2008 Aetna Provider Preferred Drug Guide, Commercial and Medicare Plans
Blue Cross Blue Shield of Western New York, Medication Guide
Empire Blue Cross, Blue Shield, Healthy Living, Summer 2005, "You CAN Quit Smoking!"
Preferred Care, 2008 Prescription Drug Formulary
Excellus, Check Our Drug Lists for Health Plans
MVP Health Care, Wellness Suite, Core Wellness
Health Plan of New York, "HIP Quit Smoking Program"
Independent Health, Drug Formulary
The Empire Plan, 2008 Empire Plan Preferred Drug List

Private Insurance Coverage Details

Type	Value	Data Source
Cessation mandate on the books	No
Mandate applies to all insurance carriers	n/a
Mandate applies to all populations	n/a
State mandates wellness program including smoking cessation	No
Other stipulations	n/a

Type	Value	Data Source
NRT Gum	n/a
NRT Patch	n/a
NRT Nasal Spray	n/a
NRT Lozenge	n/a
NRT Inhaler	n/a
Varenicline (Chantix)	n/a
Bupropion (Zyban)	n/a
Group Counseling	n/a
Individual Counseling	n/a

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