California Bill Would Require Insurers To Pay For Stop-Smoking Drugs

(July 4, 2010)


July 4, 2010

Few doubt the perils of cigarettes: Smoking kills, and it adds billions of dollars to America's escalating health care bill.

That said, is it a good idea to give would-be quitters free access to drugs that could help them kick the habit?

Doctors and health care advocates say yes, and are supporting Senate Bill 220, which would require insurers in California to cover any smoking cessation drug approved by the U.S. Food and Drug Administration. They cite research by the nonpartisan California Health Benefits Review Program, which says the legislation could save the state $45 million yearly in health care costs.

Insurers, however, say no. While the majority of health plans offer at least some level of coverage for smoking cessation, they often restrict access to some of the more expensive drugs, and require patients to complete counseling before obtaining a prescription.

Already required to comply with new federal rules, insurance companies bristle at the thought of additional state government mandates. They say SB 220 would be an $84 million gift to drug companies and might not do much to reduce smoking.

Most health insurance policies in California already cover smoking cessation programs and at least some drugs. But about 18 percent of the state's insured population has no coverage at all for smoking cessation.

The federal health care overhaul aims to change that. By 2014, all health plans participating in government-run insurance exchanges established by the federal health law must provide cessation programs in their "essential health benefits package."

SB 220 would go further by requiring all plans – not just those in the exchange – to provide coverage, and by eliminating co-pays and deductibles for smoking cessation drugs and counseling.

Sen. Leland Yee, D-San Francisco, the bill's author, said he doesn't understand why insurers would fight something that saves them money in the long run. Yee won support for the measure last month in the Assembly Health Committee.

Smoking is linked to an array of killers, including cancer, heart disease and emphysema.

"As we move this bill through the process, I hope (insurers) will understand that their opposition is penny wise, but pound foolish," Yee said.

Right now, many Californians who try to quit smoking face financial as well as physical and psychological hurdles.

Mark Shellenberger, 53, decided to get serious about kicking his 30-year, two-pack-a-day habit two years ago after failing a physical. The Sacramento man, an analyst for Conifer Health Solutions, enrolled in a smoking cessation program offered by Mercy General Hospital.

Shellenberger's insurer didn't offer the coverage, so he paid out of pocket for classes and the brand-name drug Chantix. "You would think that it would be something they would want to support and pay for because it would be to their benefit," he said.

He could afford only a six-week supply of the drug, which cost him more than $200. When his supply ran out, he relied on willpower.

Even now, the craving hasn't ceased. "I just have to make sure that I don't give in to temptation," he said.

Despite a steady decline in the number of smokers, 3.8 million California adults still smoke cigarettes.

The costs of the nation's smoking habit are high; the U.S. Centers for Disease Control and Prevention puts the annual tab at $193 billion.

The California Medical Association, the American Cancer Society and the country's leading lung and heart associations say it's time insurers did more.

"Our hope is that insurance companies will see … that there's an opportunity here to reduce costs – their own costs – by embracing full coverage for cessation treatments and services," said Paul Knepprath, a lobbyist for the American Lung Association.

But Patrick Johnston, president of the California Association of Health Plans, urged lawmakers not to issue more mandates, even for such a seemingly worthy goal.

"The perverse logic of the Legislature is to rail against insurance premium increases and then mandate a smoking cessation drug benefit that would pay pharmaceutical companies $84 million," he said. "This is a good deal for pharmaceutical companies and a bad deal for everybody else."

Kathleen McKenna, a spokeswoman for Kaiser, said the HMO is against mandates in principle and also objects to the way Yee's bill puts the full financial burden on insurers for drugs, whether for prescriptions or over-the-counter medication. Kaiser provides free cessation programs to members, but requires counseling as a prerequisite to getting medication.

Brad Kieffer, a spokesman for Health Net, said his company "endorses efforts to curb smoking," calling the addiction "one of the biggest drivers of overall health care costs." But, he said, "We don't believe that this is the right prescription," because it provides smokers with direct access to smoking-cessation drugs without counseling services.

Experts generally agree that counseling is a key part of treatment. A Health Committee analysis of SB 220 cites numerous studies showing that a combination of counseling and drugs boosts a quitter's chances of success. The bill requires health plans to offer counseling, but does not require patients to go through it before getting drugs.

As it stands, it often takes smokers many attempts to quit before kicking the habit.

Carmen Werle, a Kaiser Permanente member, resumed smoking a year ago. "It's very hard to quit, especially with a lot of stuff going in your life," said Werle, a risk manager for the state attorney general's office. "It's a stress reliever."

Although Kaiser offers smoking cessation classes, she has yet to take advantage.

"I have to quit for my health, so I can be around longer for my family," Werle said. "I'll do it when I'm ready."


Senate Bill 220 would require all health plans in California to provide free coverage for smoking cessation programs and drugs. That includes:

• Individual, group or telephone counseling, with at least four counseling sessions provided.

• All prescription and over-the-counter medications approved by the Food and Drug Administration.

• No co-payment, co-insurance or deductible for the benefit.

• No counseling required as a precondition for anti-smoking prescription drugs.

• Insurers may limit counseling and medication courses to two treatments per year.