1 thought on “Problems with Medicaid Managed Care’s Coverage of Tobacco Cessation Treatment”

  1. I am an NP at the Cleveland Clinic who provides smoking cessation to cancer and chronic disease patients. Smoking cessation visits are poorly if at all reimbursed causing an access issue as many places do not want to offer them. However, helping a patient to stop smoking is the single best way they can improve their health, reducing costs in the long run. We offer these visits at the Cleveland Clinic because its the right thing to do, and we know it improves healing in our orthopedic surgical population, it reduces chronic pain issues, it prevents complications in patients who receive radiation for cancer, so ultimately as patients quit smoking we can reduce costs in other disease states.
    A mainstay in the tobacco cessation treatment is the use of the drug varenicline. I have been amazed at how well it works in patients with long histories of tobacco use. Unfortunately, it is ALWAYS met with the barrier of prior authorization. Usually, the prior auth can be quickly handled by providing more information to the insurance company. However, often times as providers we are not notified by a pharmacy that a medication is requiring prior authorization. So, the patient gives up and never gets the medication, thus does not have the opportunity to use this effective tool to quit smoking. Sometimes, usually in the case of Molina Health, the prior auth is painful and requires multiple attempts to get the drug approved for the patient. It is not uncommon for the patient to just give up. And when I say give up, I mean giving up on trying to quit smoking altogether. The difficulty with trying to find access to a program, combined with the difficulty in getting the resources to quit, frustrates those who already feel like they can’t do it. I believe we can improve this as a community. We are willing to create the access, but please help our patients get the tools they need to be successful.

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