Thursday, November 1, 2018

Colorado Medicaid Opens Up Coverage for Smoking Cessation

Smoking cessation medications are a covered benefit for all Health First Colorado members, though some of these medications currently require prior authorization approval for coverage. As part of continued efforts to reduce smoking and tobacco use among Health First Colorado members, beginning November 1, 2018, all FDA-approved smoking cessation medications will be eligible for coverage without a prior authorization. These medications include varenicline, bupropion, nicotine inhaler, nicotine spray, nicotine patch, nicotine lozenge and nicotine gum. Additional information on coverage for smoking cessation medications can be found in Appendix P.  

Prior authorization has been shown to impede patients’ ability to obtain timely access to medications, which can deter motivation to follow through on a quit attempt. Research demonstrates that a tobacco cessation benefit that includes comprehensive coverage, has few barriers to access, and is promoted to smokers and their health care providers can be widely used, substantially reduce smoking prevalence, lead to improved health outcomes, and achieve a favorable return on investment by reducing health care costs.

 In 2016, Colorado Medicaid and CDPHE partnered under CDC’s 6|18 initiative, working together to improve access to and use of Medicaid-covered cessation treatments. Through this partnership, Colorado successfully removed copays for all FDA-approved cessation medications, supported enactment of regulatory changes to allow pharmacists and home visiting nurses to deliver cessation services, and developed consumer and provider resources to support promotion of Medicaid cessation benefits. 

This is a big step forward for smoking cessation coverage in the state of Colorado, and a testament to the value of the partnership between Colorado Medicaid and CDPHE and our shared commitment to improving the health of all Coloradans. 

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