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State of Tobacco Control 2018State of Tobacco Control 2018State of Tobacco Control 2018

Federal Cessation Treatment Coverage

The cessation treatment coverage criteria used in the American Lung Association's "State of Tobacco Control" 2018 report are based on the coverage of tobacco cessation treatments provided by the federal government through its four main public insurance programs:

  1. Medicare (for Americans over age 65),
  2. Medicaid (for low-income and/or disabled Americans),
  3. TRICARE (for members of the military and their families), and
  4. Federal Employee Health Benefits Program (for federal employees and their families).

A fifth category covers federal requirements for tobacco cessation treatment coverage in state health insurance exchanges under the Patient Protection and Affordable Care Act or health care reform law. Providing help to quit through these programs and state health insurance exchanges will reach large numbers of tobacco users, improve health, prevent unnecessary death, save taxpayer money and set an example for other health plans. The federal government must lead by example and cover a comprehensive benefit for everyone to whom it provides health care.

The definition of a comprehensive tobacco cessation benefit used in these criteria follows the recommendations in the Clinical Practice Guideline entitled Treating Tobacco Use and Dependence. In this Guideline, published in 2008 the U.S. Public Health Service recommends the use of seven medications and three types of counseling as effective for helping tobacco users quit. This definition has been reaffirmed in the 2015 United States Preventive Services Task Force (USPSTF) recommendation.

The cessation coverage grade breaks down as follows:

Grade

Points Earned

A

18 to 20 Total Points

B

16 to 17 Total Points

C

14 to 15 Total Points

D

12 to 13 Total Points

F

Under 12 Total Points

Medicare (4 points)

Target is all Medicare recipients have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Medicaid (4 points)

Target is all Medicaid enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are required to be covered.
  • +3 points: At least 4 medications and 1 type of counseling are required to be covered.
  • +2 points: At least 2 medications and 1 type of counseling are required to be covered.
  • +1 point: At least 1 treatment is required to be covered.
  • +0 points: No required coverage.

TRICARE (4 points)

Target is all TRICARE enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Employee Health Benefits (FEHB) (4 points)

Target is all federal employees & dependents have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Requirements for State Health Insurance Exchanges

Target is all plans in exchanges cover a comprehensive tobacco cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: Guidance released outlining coverage of a comprehensive tobacco cessation benefit as a preventive service.
  • +2 points: Administration has not updated guidance to payers and insurance plans in response to updated USPSTF recommendations in a timely manner.
  • +1 points: At least 1 recommended tobacco cessation treatment is required to be covered.
  • +0 points: No coverage is required, or regulation is not published.

Bonus Points: 1 bonus point in each category is awarded if coverage is provided with minimal barriers to access.


    Did You Know?

    1. More than 1 in 5 high school students in the U.S. use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    2. 7.2 percent of middle school students use at least one tobacco product, including e-cigarettes, according to the 2016 National Youth Tobacco Survey.
    3. A 2014 article in the Journal of the American Medical Association found that about 8 million lives have been saved through tobacco control efforts since 1964, including 800,000 lung cancer deaths between 1975 and 2000.
    4. Smoking is the number one preventable cause of death in the U.S., killing over 480,000 people per year.
    5. Secondhand smoke kills more than 41,000 people in the U.S. each year.
    6. 28 states and Washington D.C. have passed laws making virtually all public places and workplaces, including restaurants and bars smokefree.
    7. Connecticut and New York have the highest cigarette taxes in the country at $4.35 per pack.
    8. Missouri has the lowest cigarette tax in the country at 17 cents per pack.
    9. The average of all states plus the District of Columbia's cigarette taxes are $1.72 per pack.
    10. Ten states have taxes on other tobacco products equivalent to their state's cigarette taxes.
    11. Alaska is the only state that is funding their tobacco control programs at or above the CDC-recommended level (in Fiscal Year 2018).
    12. Three states increased their cigarette taxes in 2017.
    13. No state approved a comprehensive smokefree workplace law in 2017.
    14. 9 states – California, Connecticut, Indiana, Kentucky, Maine, Massachusetts, Missouri, Ohio and South Carolina– offer a comprehensive cessation benefit to tobacco users on Medicaid.
    15. Each of the 50 states and the District of Columbia provide tobacco quitlines, a phone number for quit smoking phone counseling. The median amount states invest in quitlines is $2.10 per smoker in the state.
    16. Maine, New Jersey and Oregon passed legislation increasing their minimum sales ages for tobacco products to 21 in 2017.
    17. Five states and over 280 communities in 18 different states have passed Tobacco 21 laws.
    18. Nationwide, the Medicaid program spends more than $22 billion in healthcare costs for smoking-related diseases each year – more than 11 percent of total Medicaid spending.
    19. In 2009, the American Lung Association played a key role in the passage of the Family Smoking Prevention and Tobacco Control Act, which gives the U.S. Food and Drug Administration authority over tobacco products.
    20. The American Lung Association played a key role in airplanes becoming smokefree in the 1990s.
    21. 42 states and Washington D.C. spend less than half of what the CDC recommends on their state tobacco prevention programs.
    22. States spend less than three cents of every dollar they get from tobacco settlement payments and tobacco taxes to fight tobacco use.
    23. Each day, more than 2,300 kids under 18 try their first cigarette and close to 400 kids become new, regular smokers.
    24. Each day, close to 1,900 kids try their first cigar. On average, close to 80 kids try their first cigar every hour in the United States – equaling close to 690,000 every year.
    25. Smoking costs the U.S. economy over $332 billion in direct health care costs and lost productivity every year.
    26. The five largest cigarette companies spent over $22 million dollars per day marketing their products in 2015.
    27. Secondhand smoke causes $5.6 billion in lost productivity in the U.S. each year.
    28. Smoking rates are over twice as high for Medicaid recipients compared to those with private insurance.
    29. A 2013 study of California's tobacco prevention program shows that the state saved $55 in healthcare costs for every $1 invested from 1989 to 2008.
    30. A 2012 study of Massachusetts' comprehensive Medicaid quit smoking benefit found that Massachusetts saved $3 for every $1 spent helping smokers quit in just over a year.
    31. In 2017, Kentucky and South Carolina made major improvements to their quit smoking coverage for Medicaid enrollees and others.
    32. Uninsured Americans smoke at a rate two times higher than people with private insurance.
    33. An estimated one third of Americans living in public housing smoke.
    34. One study found persons with behavioral health and substance abuse disorders consume about 40 percent of the cigarettes sold in the U.S.
    35. Native Americans and Alaska Natives have the highest smoking rates among any racial/ethnic group.
    Get more facts »

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