Almost All State Health Insurance Marketplace Plans Do Not Offer Required Quit Smoking Coverage, New Report Reveals | American Lung Association

Almost All State Health Insurance Marketplace Plans Do Not Offer Required Quit Smoking Coverage, New Report Reveals

New Report from American Lung Association Finds Opportunity for Millions to Quit Smoking Ignored by Health Insurance Plans and Policymakers

(March 31, 2015) - Chicago, IL

The overwhelming majority of state health insurance marketplace plans are not providing the coverage they should be for smoking cessation. Millions of Americans who have enrolled in health insurance marketplace plans should be provided with free tools to quit smoking, but a new report from the American Lung Association shows fewer than 20 percent of plan issuers are providing the appropriate coverage.   

State health insurance marketplace plans are required by the Affordable Care Act (ACA) to help smokers quit as a free essential health benefit. The new State Health Insurance Marketplace Plans report concludes that the vast majority of these plans are falling short.

The report shows that only 60 plan issuers out of 348 (17 percent) are covering tobacco cessation medications with no cost-sharing as required in the Affordable Care Act, and fewer than half of issuers list those seven approved cessation medications on their publically available drug lists, or formularies. Only one state, West Virginia, had all plans in the marketplace covering all tobacco cessation medications. West Virginia has only one plan issuer selling plans in its marketplace. 

“State marketplaces are falling woefully short of helping millions of Americans quit smoking,” said Harold P. Wimmer, National President and CEO of the American Lung Association. “Evidence suggests that smoking rates of people enrolled in marketplace plans are high, which means there’s a unique opportunity to help millions quit.”

According to the ACA and federal guidance, all plans should cover a comprehensive tobacco cessation benefit:

  • At least four sessions of individual, group and telephone cessation counseling
  • All FDA-approved tobacco cessation medications (nicotine patch, gum, lozenge, nasal spray and inhaler; bupropion and varenicline)
  • At least two quit attempts per year
  • No cost-sharing, like copays, coinsurance or deductibles
  • No prior authorization requirements

“Quitting is hard and the Lung Association knows that making sure everyone has access to all quit smoking medications and counseling is critical to saving lives,” Wimmer said. “Federal and state policy makers must make sure insurance plans are covering a comprehensive cessation benefit with no-cost sharing. Not only will it save lives, but it is also the law.”

Tobacco use is the number-one preventable cause of disease and death in the United States, and is responsible for almost 500,000 deaths each year. Tobacco use costs our country over $289 billion annually in smoking-related healthcare expenses and lost productivity. Almost 70 percent of smokers want to quit.

For media interested in speaking with an expert about lung health and tobacco use, contact the American Lung Association at media@lung.org or 312-801-7628.

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