Selecting Benefits
As mentioned in the Benefits section of this website, cost analyses have shown that tobacco cessation benefits, from an employer's perspective, are cost-saving.1 Benefits must be introduced concurrently or before a workplace policy is established. In order to make a smooth transition to the new workplace policy, employees who use tobacco must have tobacco cessation benefits available to them. As more and more employers come to understand the value behind tobacco cessation benefits, they face the task of purchasing such benefits. This is an undertaking that needs adequate support and guidance. The following section will provide pertinent information pertaining to purchasing tobacco cessation benefits.
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| Eliminate or minimize co-pays or deductibles for counseling and medications. Even small copayments reduce the use of proven treatment. |
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Benefits Package Options
Beneficiaries
Who is eligible for the tobacco cessation program and benefits?
- Employees
- Full-time
- Part-time
- Contractors
- Spouse/Domestic partners
- Children
- Dependents over 18
- Other dependents
Medications
Which medications will be included in the benefit package?
- Over-the-counter nicotine replacement therapy (i.e., gum, patch or lozenge)
- Free?
- Reduced copayment?
- Cost sharing?
- Prescription nicotine replacement therapy (i.e., nicotine inhaler or nicotine nasal spray)
- 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 U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention, 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
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
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| 99403 |
Preventive medicine counseling/risk factor reduction, 45 minutes
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| 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
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| 99407 |
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
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| 99078 |
Physician educational services in a group setting
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| S9075 |
Tobacco use treatment
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| S9453 |
Tobacco cessation classes, non-physician provider, per session
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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. |
For more information about medication and counseling options, please see the Treatment Options section of this website.
Health Promotion/Wellness and Employee Assistance Programs
Choosing a Vendor
Some employers choose to use a tobacco cessation vendor because vendors can assist with the roll out of a dynamic and comprehensive tobacco cessation program. Vendors can provide employers with more flexibility for implementing and changing tobacco cessation programs. Employers using vendors are not limited to changes only during the benefits cycle. Many vendors work in collaboration with the employer to take care of the entire spectrum of the program such as planning, implementation, facilitation, and evaluation. Upon deciding to use a tobacco cessation vendor, it is a good idea to write a Request for Proposal (RFP) in order to obtain tailored proposals from vendors that address the company's specific needs and employee population.
Request for Proposal (RFP)
The following information can aid employers when creating a RFP and evaluating proposals from vendors.
- Establish possible vendor qualifications and responsibilities to be included in the RFP.
- Decide which questions on the RFP are most important. Vendor answers to these questions need to be evaluated carefully and should be weighted more when scoring.
- Develop scoring ranges and create categories such as "unacceptable," "marginal," and "acceptable."
- Determine tie-breaking criteria for vendors with similar scores within the "acceptable" range. For example, previous experience with the vendor, vendor reputation, or price.
Employers should contract with vendors who adapt tobacco cessation evidence-based treatment recommendations from organizations such as:
- Agency for Healthcare Research and Quality Evidence-Based Practice Centers (AHRQ)
- National Guideline Clearinghouse™ (NGC)
- National Institute of Mental Health (NIMH)
- US Preventive Services Task Force (USPSTF)
- Centers for Disease Control and Prevention (CDC)
Scoring of proposals should also be established using evidence-based recommendations from the above agencies as the "gold standard." For example, gold standard practices are:
- Screening for tobacco use at every clinical encounter.
- Providing brief counseling (in-person) and intensive counseling (in-person or over the telephone) for tobacco cessation treatment (2 courses of 6 counseling sessions per calendar year).
- Making all FDA-approved nicotine replacement products and tobacco cessation medications (over-the-counter and prescription) available.
Qualifications of the Vendor
- How long has the vendor been in existence? How long have they provided tobacco cessation programs?
- Have others been satisfied with the vendor?
- Will the vendor provide a list of clients?
- Will the vendor provide references?
- Will the vendor provide aggregated quit rates for other clients they serve?
- How much does the program cost per employee served? Are group discounts available?
- Does the vendor use methods based on research?
- How does the vendor address the psychological, physical, and behavioral components to tobacco cessation?
- Have the results of the vendor's program ever been evaluated by a third party?
- How many people have participated in the program?
- How many businesses/employers does the vendor currently serve?
- What percentage of the people who started the program completed it?
- What are the quit rates at 3, 6 and 12 month intervals after completing the program?
- Does the program have the capacity to serve the employee population?
- Will the structure of the program accommodate the needs of employees?
- Have the vendors worked with an employee population similar to the employee population at hand?
- How many sessions are included?
- What are the qualifications of the tobacco cessation instructors/coaches?
- What training have they received?
- What experience do they have counseling individuals with tobacco addiction?
- Do they understand the phases of tobacco addiction?
- What internal measures are in place to assure quality and service provision?
- Are they able to create an individualized treatment plan for each participant?
Implementation
- What resources will the vendor provide to help promote the program to employees and stimulate participation?
- What is the timeline of the implementation process?
- What is required from the employer to implement the program?
- How is the program delivered?
- Is there a telephone-based component?
- Is there a web-based component?
- Is there the opportunity for in-person counseling?
- Are there written materials?
- Are these materials culturally sensitive?
- Are these materials written at an appropriate reading level?
- Does the program include medications?
- If so, how do employees/clients access nicotine replacement therapy or prescription medications?
- What percentage of employees/clients receive medications?
- How many employees/clients fill medication prescriptions at pharmacy (if not provided directly from the program)?
- Will the program provider:
- Accommodate all shifts?
- Make available on-site and off-site programs?
- Structure flexible program formats?
- Supply audio or visual materials and equipment?
Incentives
Incentives may be useful for increasing interest and participation in tobacco cessation programs. However, long-term outcome research regarding successful quitting using incentives still needs to be conducted. Employers need to decide:
- Will incentives be offered to employees to join the program?
- Will incentives be offered when employees reach important milestones (i.e., quit for 3 months, quit for 6 months, quit for 1 year)?
- Will incentives be offered to employees who complete the program successfully (i.e., quit for 6 months or more)?
For additional information about types of incentives, advantages, and disadvantages of incentives please review the Health Plan Benefits section of this website.
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.
Expected Outcomes
- How does the vendor calculate quit rates (i.e., quit for 3 months, quit for 6 months, quit for 1 year)?
- How are employees classified (quit, not quit, or lost to follow-up) that are unavailable for follow-up at 6-months after completion?
- How are employees classified (quit, not quit, or lost to follow-up) that are unavailable for follow-up at 1-year after completion?
- What are the 6-month and 1-year quit rates among program participants? (A range of 20%-30% quit rate is realistic.)
- Does the program offer any form of guarantee?
Evaluation
- Will the vendor conduct program evaluation?
- For example, will they provide monthly data reports?
- Is the vendor willing to offer ongoing assistance and follow-up once the formal program ends?
The following link, authored by the Centers for Disease Control and Prevention, will provide useful information to employers about offering cessation services with guidance on announcing, enforcing, and monitoring the policy.
Implementing the Initiative
Citation
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.
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