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Updated November 10, 2011

Overview
Choosing Tobacco Cessation Benefits
Recommended Comprehensive Tobacco Cessation Benefits
      Additional Tobacco Cessation Benefit Recommendations
      Increasing Tobacco Cessation Benefit Utilization
Incentives
2010 State Laws Regarding Tobacco Cessation Benefit Coverage
Resources
Citations

Overview

Tobacco use causes serious health problems. Cost analyses have shown that tobacco cessation benefits, from an employer's perspective, are cost-saving.1 Like all other health benefit decisions, employers need to make informed decisions when considering providing tobacco cessation benefits. The information below will assist employers in choosing tailored benefits, as well as identifying evidence-based benefits for tobacco cessation.


Choosing Tobacco Cessation Benefits

The information provided in the Business Case section of this website provides compelling information on the financial advantages of choosing comprehensive tobacco cessation benefits. Benefit managers struggle with complex and sometimes contentious resource allocation decisions. Each year, benefits department staff must decide which healthcare services to cover in their plan(s) and at what level. Typically, these decisions are a function of cost, employee and/or union negotiations, and precedent.2 Furthermore, many employers choose to contract with a vendor specializing in tobacco cessation services. Many vendors work in collaboration with the employer to take care of the entire spectrum of the tobacco cessation program such as planning, implementation, facilitation, and evaluation.

Eliminate or minimize co-pays or deductibles for counseling and medications. Even small copayments reduce the use of proven treatment.

Benefits Package Options
Employers have the responsibility of deciding who will be able to access tobacco cessation benefits and what treatment options will be available to covered individuals.

Beneficiaries
Who is eligible for the tobacco cessation program and benefits?

  • Employees
    • Full-time
    • Part-time
    • Contractors
  • Spouse/Domestic partners
  • Children
  • Dependents over 18
Medications
Which medications will be included in the benefit package?
  • Nicotine replacement therapy (i.e., gum, patch or lozenge)
    • Free?
    • Reduced copayment?
    • Cost sharing?
  • Bupropion SR (trade name Wellbutrin® and Zyban®)
    • Free?
    • Reduced copayment?
    • Cost sharing?
  • Varenicline (trade name Chantix™)
    • Free?
    • Reduced copayment?
    • Cost sharing?
Counseling
Based upon the evidence-based recommendations of the US Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC), the Business Group encourages employers to cover brief counseling (in-person) and intensive counseling (in-person or over-the-telephone) for tobacco use treatment.1 It is also recommended that employers cover 2 courses of 6 counseling sessions per calendar year for employees and beneficiaries who meet criteria.1 Counseling options include:
  • Telephone-based programs
  • Individual counseling programs
  • Group programs
  • Internet self-help programs

Recommended Comprehensive Tobacco Cessation Benefits

A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage is a National Business Group on Health informational tool for employers to assist with the design of clinical preventive services benefits. A Purchaser's Guide provides guidance about clinical preventive services shown to be effective by the US Preventive Services Task Force (USPSTF), the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ). The section of the Purchaser's Guide with summary plan description language for tobacco cessation follows.

Summary Plan Description Language:
Tobacco Cessation Screening
Covered Screening Screening for tobacco use is a covered benefit beginning at age 18. Coverage is provided for younger populations depending on risk and need.
Screening Initiation and Interval Screening may be conducted at every clinical encounter.
Summary Plan Description Language:
Tobacco Cessation Counseling
Covered Counseling Brief counseling (in-person) and intensive counseling (in-person or over-the-telephone) are covered benefits for tobacco cessation treatment.
Counseling Initiation and Interval Beneficiaries who meet criteria are eligible for 2 courses of 6 counseling sessions per calendar year, for a total of 12 sessions per calendar year.
Summary Plan Description Language:
Tobacco Cessation Treatment
Covered Treatment All FDA-approved nicotine replacement products and tobacco cessation medications (over-the-counter and prescription) are covered.
Treatment Initiation and Interval Medications are covered as prescribed by a clinician.
Treatment Services Not Covered Neither hypnosis nor acupuncture has been demonstrated to be effective for tobacco cessation and these services are therefore not covered.
Source: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A purchaser's guide to clinical preventive services: moving science into coverage. Washington, DC: National Business Group on Health; 2006.

Tobacco Cessation
Current Procedural Terminology Codes (CPT© Codes)
Tobacco Use Treatment (Screening)
99420 Administration/interpretation health risk assessment instrument
Tobacco Use Treatment (Counseling)
99401 Preventive medicine counseling/risk factor reduction, 15 minutes
99402 Preventive medicine counseling/risk factor reduction, 30 minutes
99403 Preventive medicine counseling/risk factor reduction, 45 minutes
99404 Preventive medicine counseling/risk factor reduction, 60 minutes
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99078 Physician educational services in a group setting
S9075 Tobacco use treatment
S9453 Tobacco cessation classes, non-physician provider, per session
Note: This list is complete and up-to-date as of July 18, 2008. Please refer to AMA/CPT publications as the current, authoritative source.

Resource:
A Purchaser's Guide to Clinical Preventive Services

Tobacco Cessation (ICD-10 Codes)
International Statistical Classification of
Diseases and Related Health Problems
10th Revision, Version for 2007
F17 Mental and behavioral disorders due to use of tobacco
F17.1 Mental and behavioral disorders due to use of tobacco
F17.2 Mental and behavioral disorders due to use of tobacco
F17.0 Mental and behavioral disorders due to use of tobacco
F17.3 Mental and behavioral disorders due to use of tobacco
F17.9 Mental and behavioral disorders due to use of tobacco
P04.2 Fetus and newborn affected by maternal use of tobacco
T65.2 Toxic effect: Tobacco and nicotine
Z58.7 Exposure to tobacco smoke
Z71.6 Tobacco abuse counseling
Z72.0 Tobacco use
Z81.2 Family history of tobacco abuse
Z86.4 Personal history of psychoactive substance abuse
Source: World Health Organization, International Statistical Classification of Diseases and Related Health Problems, 10th Revision Version for 2007. Available at: http://www.who.int/classifications/apps/icd/icd10online/. Accessed: October 21, 2008.

Note: This list is complete and up-to-date as of October 21, 2008. Please refer to World Health Organization ICD Codes as the current, authoritative source.


Additional Tobacco Cessation Benefit Recommendations:

  • Request Healthcare Effectiveness Data and Information Set (HEDIS®) data related to advising tobacco users to quit.
    • HEDIS® is a tool used by more than 90% of America's health plans to measure performance on important dimensions of care and service.
    • Performance measures exist to evaluate provision of medications, support, and assistance with quitting.
  • Ask for all health plan options (benefits, riders, products, programs, discounts, incentives, other) that address tobacco use. An estimated 10% of smokers per year would utilize treatment when a full benefit is provided, as compared to 2.4% of smokers with a partial benefit.3
  • Increase health and productivity and lower costs by purchasing a health plan that incorporates preventive benefits.
  • Reimburse primary health care providers (PCPs) for using an assessment tool about tobacco for referral to telephone counseling, in-person counseling, group counseling, or individual counseling.
  • Encourage health plans and health care providers to use Current Procedural Terminology (CPT©) codes for tobacco dependence.
  • Eliminate or minimize co-pays or deductibles for counseling and medications. Even small copayments reduce the use of proven treatment.

Increasing Tobacco Cessation Benefit Utilization

Experience has shown that providing comprehensive health benefits is not sufficient to ensure good health for any population: engagement, appropriate utilization, and quality are necessary factors as well. In order for beneficiaries to become engaged in health promotion and healthcare decision-making, they need education on the importance of these activities, resources and tools, appropriate incentives, and employer support.2

Strategies for building tobacco cessation benefit appeal, use, and demand:
  • Create a benefit package that allows employees an opportunity to test or experiment with a service/product before buying it (i.e., pharmacy-administered "trial" packages of multiple forms of NRT).4
  • Make the initial quit attempt less costly, both psychologically and financially (i.e., short-term "practice" quit attempts).4
  • Integrate multiple treatment elements in a unified system of care (i.e., pharmacy plan for medications and mental health plan for counseling).4
  • Include benefit promotion products, tools, and services that create a positive experience for employees, especially underserved populations.4
  • Make the connection that quitting is a lifestyle decision, not exclusively a health decision. Link individuals to services and supports in other areas (i.e., exercise, weight control, and stress management).4

Incentives

A 2009 study of employees of a multinational company indicated that financial incentives can increase tobacco cessation program enrollment rates, completion of programs and abstinence rates.5

Examples of incentives:
  • Benefit enhancements.
  • Lower deductibles.
  • Reduced premiums.
  • Flexible benefit credits to attend tobacco cessation classes or telephone counseling.
  • Cash incentives to improve health risk factors.
  • Cash incentives for health education programs.
Advantages of Incentives Disadvantages of Incentives
  • Easy to set up and operate.
  • Very flexible and adaptable.
  • Can have significant behavioral impact.
  • Can be designed for different departments and different levels.
  • Can be linked to organizational goals and objectives.
  • Encourage cessation program participation.
  • Give employees a positive focus.
  • Reinforce motivation to quit.
  • Reinforce employees' not using tobacco.
  • Determining the best reward may be difficult.
  • Employees can falsify cessation attempts.
  • Non-tobacco users might feel slighted.
Source: Centers for Disease Control and Prevention. Making your Workplace Smoke-Free: A Decision Makers Guide. Available at: http://www.cdc.gov/tobacco/basic_information/secondhand_smoke/index.htm. Accessed August 3, 2011.

For more information about whether employers can offer discounted health premiums for nonsmokers without violating federal laws visit the National Business Group on Health's Issue Brief: Employers Can Provide Financial Incentives Such As Contribution/Premium Discounts to Their Nonsmoking Employees Through a Bona Fide Wellness Program.


2010 State Laws Regarding Tobacco Cessation Benefit Coverage:6

Kentucky

  • Kentucky law specifies that it is not unlawful for employee contribution rates for smokers and nonsmokers to differ under employer-sponsored health plans.
  • Kentucky law specifies that it is not unlawful for benefits or incentives to be offered by an employer to an employee for participating in smoking cessation programs.
  • Kentucky allocated funding in state appropriations/budgets for tobacco cessation benefits for Medicaid for the first time.
  • Legislation passed allowing employers to offer benefits or incentives to employees who enroll in smoking cessation programs.

Missouri

  • Missouri allocated funding in state appropriations/budgets for tobacco cessation benefits for Medicaid for the first time.

Nebraska

  • Nebraska continued providing specific funding for its Medicaid cessation coverage benefit.

North Carolina

  • North Carolina enacted a law requiring the Executive Administrator of the State Health Plan to consult with a legislative committee before implementing any tobacco use testing program on plan members.

South Carolina

  • South Carolina enacted a law allowing an additional surcharge for State Employee Health Plan enrollees who use tobacco. The surcharge cannot exceed $40 per month for a subscriber or $60 per month for a subscriber and dependents.

Vermont

  • Vermont law requires public and private health insurers to cover at least one three-month supply per year of tobacco cessation medication, including over-the-counter medication. Tobacco cessation medication includes all therapies approved by the U.S. Food and Drug Administration.

Resources

Centers for Disease Control and Prevention

A Practical Guide to Working with Health-Care Systems on Tobacco-Use Treatment

A Centers for Disease Control and Prevention (CDC) publication provides information and practical advice to help public health professionals and employers improve their understanding of health-care systems, improve tobacco dependence treatment, and increase cessation.

Pacific Business Group on Health
Tobacco Cessation Benefit Coverage and Consumer Engagement Strategies: A California Perspective



Citations

1 Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A purchaser's guide to clinical preventive services: moving science into coverage. Washington, DC: National Business Group on Health; 2006.
2 Campbell KP, ed. Investing in maternal and child health: an employer's toolkit. Washington, DC: Center for Prevention and Health Services, National Business Group on Health; 2007.
3 Curry S, Grothaus M, McAfee T, et al. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. NEJM. 1998;339(10):673-679.
4 Orleans T. Increasing the demand for and use of effective smoking-cessation treatments. Am J Prev Med. 2007;33(6S):S340-S348.
5 Volp KG, Troxel AB, Pauly MV et al. A randomized, controlled trial of financial incentives for smoking cessation. NEJM. 2009;360(7):699-709.
6 American Lung Association. State Legislated Actions on Tobacco Issues 2010. Available at: http://www.lungusa2.org/slati/reports/SLATI_2010_Final_Web.pdf. Accessed November 8, 2011.

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