State Tobacco Cessation Coverage

Medicaid Coverage

The Pennsylvania 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 original prescription plus five refills. Counseling is limited to 10 sessions of at least 15 minutes. Counseling is also limited to 70 days of counseling per year. Prior authorization may be required, and co-payments of $1-3 are required. Please note that this information reflects coverage that the Pennsylvania Department of Public Welfare requires all managed care organizations (MCOs) to provide. Some MCOs, however, do not presently comply with this directive.

For more information, please call the Office of Medical Assistance Programs at 717-787-1870, or visit their website at http://www.dpw.state.pa.us/OMAP/

View Medicaid Coverage Details

State Employee Health Plan Coverage

The Pennsylvania Employee Benefits Trust Fund covers:

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

Bupropion (Zyban)
Group Counseling
Individual Counseling
Phone Counseling

Patients must receive medications through the Quit Power telephone counseling program. To enroll, call 877-950-5008 or go to http://pebtf.healthatoz.com

For more information, please call the Pennsylvania Employees Benefit Trust Fund at 717-561-4750 or 800-522-7279, or visit their website at http://www.pebtf.org/

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 Pennsylvania Free Quitline is open 6AM-11PM (M-TH), 6AMâ"8PM (F), 8AM-6PM (SAT-SUN) (Eastern Time). You can reach the Pennsylvania Free Quitline by calling 1-800-QUIT-NOW.

American Lung Association Resources

The American Lung Association's Freedom From Smoking® program is widely available in community locations throughout Pennsylvania. 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

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?
NRT Gum	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
NRT Patch	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
NRT Nasal Spray	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
NRT Lozenge	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
NRT Inhaler	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Varenicline (Chantix)	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Bupropion (Zyban)	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Group Counseling	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Individual Counseling	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-02-02, January 16, 2002, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Lifetime limit on quit attempts	No
Annual limit on quit attempts	Yes	Commonwealth of Pennsylvania, Department of Public Welfare, Medical Assistance Bulletin, Number 99-04-11, September 14, 2004, "Coverage of Tobacco Cessation Drug Products and Counseling Services"
Prior authorization required	Varies
Co-payments required	Yes	Pennsylvania Medicaid Provider Bulletion, August 9, 2005, "New Imposed Copays"
Stepped-care therapy	No
Counseling Required for Medications	No
Dollar Limit	No
Other

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?
NRT Gum	Yes	Public Employees Benefit Trust Fund, Get Healthy Program 2008
NRT Patch	Yes	Public Employees Benefit Trust Fund, Get Healthy Program 2008
NRT Nasal Spray	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
NRT Lozenge	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
NRT Inhaler	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
Varenicline (Chantix)	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
Bupropion (Zyban)	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
Group Counseling	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
Individual Counseling	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005
Phone Counseling	Yes	Public Employees Benefit Trust Fund, Get Healthy Program 2008
Online Counseling	Yes	Public Employees Benefit Trust Fund, Get Healthy Program 2008
Quit Kit	No	Pennsylvania Employee Benefits Trust Fund, Summary Plan Description, January 2005

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	No
Lifetime limit on quit attempts	No
Annual limit on quit attempts	No
Prior authorization required	No
Co-payments required	No
Stepped-care therapy	No
Counseling Required for Medications	Yes	Public Employees Benefit Trust Fund, Get Healthy Program 2008
Dollar Limit	No

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

Stop Smoking

Lung HelpLine

E-Newsletter

Pennsylvania

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