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Coverage For Tobacco Use Cessation Treatments

Full Report in Adobe Acrobat Format ( PDF-152K)

On This Page • Why Is Health Insurance Coverage for Tobacco Use Treatments So Important? • What Treatments Are Available? How Effective Are They? • How Should Benefits Be Designed?

Why Is Health Insurance Coverage for Tobacco Use Treatments So Important?

• Smoking is costly to employers both in terms of smoking-related medical expenses and lost productivity.
  • Ten percent of smokers alive today are living with a smoking-related illness.¹
  • Men who smoke incur $15,800² (in 2002 dollars) more in lifetime medical expenses and are absent from work 4 days more per year than men who do not smoke.³
  • Women who smoke incur $17,500² (in 2002 dollars) more in lifetime medical expenses and are absent from work 2 days more each year than nonsmoking women.³
  • In 1999, each adult smoker cost employers $1,760 in lost productivity and $1,623 in excess medical expenditures.⁴
  • Smoking causes heart disease, stroke, multiple cancers, respiratory diseases, and other costly illnesses. Secondhand smoke causes lung disease and lung cancer.^{5, 6}
  • Smoking increases costly complications of pregnancy, such as pre-term delivery and low birth-weight infants.⁷

• Smoking is the leading preventable cause of death in the United States.⁸,⁹ Smokers who quit will, on average, live longer and have fewer years living with disability.¹⁰
  
• About 23% of American adults and 28% of teens smoke.¹¹,¹² More than 70% want to quit, but few succeed without help.¹¹ Tobacco use treatment doubles quitting success rates.⁹

Paying for tobacco use cessation treatments is the single most cost-effective health insurance benefit for adults that can be provided to employees.^13,14,15

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What Treatments Are Available? How Effective Are They?

Smoking cessation treatments have been found to be safe and effective. These include counseling and medications, or a combination of both.⁹

• Face-to-face counseling and interactive telephone counseling are more effective than services that only provide educational or self-help materials. ^{9, 16}
  
• The effectiveness of counseling services increases as their intensity (the number and length of sessions) increases.⁹
  
• Smokers are more likely to use telephone counseling than to participate in individual or group counseling sessions.^{16, 17}
   
• The Food and Drug Administration has approved six first-line medications to help smokers quit:
  • Five are nicotine replacement therapies that relieve withdrawal symptoms. They include nicotine gum, patch, nasal spray, inhaler, and lozenge.⁹
  • The sixth medication, bupropion SR (sustained release), is a non-nicotine medication that is thought to reduce the urge to smoke by affecting the same chemical messengers in the brain that are affected by nicotine.⁹

Prescription and Over-the-Counter Tobacco Cessation Medications*

* Approved by the Food and Drug Administration (FDA) and addressed in the 2000 PHS Guidelines.
** Received FDA approval on October 31, 2002, therefore not addressed in the 2000 PHS Guidelines.

Scientifically proven treatments can double a person's chances of quitting smoking.⁹

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How Should Benefits Be Designed?

Benefits for proven tobacco-use cessation treatments have been shown to increase treatment use and the number of successful quitters; therefore, both the Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence, and the Community Preventive Services Task Force recommend that all insurers provide tobacco cessation benefits that do the following:

• Cover at least four counseling sessions of at least 30 minutes each,⁹ including proactive telephone counseling and individual counseling. While classes are also effective, few smokers attend them.¹⁹
   
  • Ten percent of smokers alive today are living with a smoking-related illness.¹
  • Cover both prescription and over-the-counter nicotine replacement medication and bupropion (see medication table).⁹
  • Provide counseling and medication coverage for at least two smoking cessation attempts per year.^20,21
  • Eliminate or minimize co-pays or deductibles for counseling and medications, as even small copayments reduce the use of proven treatments.^18,19
    

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This page last reviewed January 05, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health