Medicaid Coverage

MassHealth covers:

  • yesNRT Gum
  • yesNRT Patch
  • yesNRT Nasal Spray
  • yesNRT Lozenge
  • yesNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • yesGroup Counseling
  • yesIndividual Counseling
  • yesQuitline
  • yesSubmitted Section 2502 SPA?

Co-payments of $1 are required for generic medications, and co-payments of $3 are required for brand name medications. Prior authorization is required for the NRT nasal spray and inhaler, and if the patient wants to extend treatment duration past 90 days (24 weeks for varenicline). Prior authorization is also required if number of quit attempts exceed 2 per year. Group and individual counseling sessions are limited to 16 per year.

For more information, please call the MassHealth program at 617-573-1770, or visit their website at http://www.mass.gov/?pageID=eohhs2subtopic&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3=MassHealth&sid=Eeohhs2

Note: the Affordable Care Act requires all Medicaid programs cover all tobacco cessation medications beginning January 1, 2014. If a medication is marked here as not being covered, there is not yet evidence that Medicaid has complied with this requirement. Patients should call their Medicaid program and ask how to receive these medications. Also note: the coverage information above applies to traditional Medicaid. Coverage information for the Medicaid expansion population is still to be determined.

Health Insurance Marketplace Coverage

All plans in the Health Insurance Marketplace are required to cover tobacco cessation treatment. Specific coverage varies by plan. Check with your insurance plan to find out what is covered.

State Employee Health Plan Coverage

The Group Insurance Commission (GIC) covers:

  • noNRT Gum
  • noNRT Patch
  • yesNRT Nasal Spray
  • noNRT Lozenge
  • yesNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • yesGroup Counseling
  • yesIndividual Counseling
  • yesPhone Counseling
  • noOnline Counseling
  • yesNo Tobacco Surcharge

Counseling is limited to up to 300 minutes per year.

For more information, please call the Massachusetts Group Insurance Commission at 617-727-2310, or visit their website at http://www.mass.gov/gic/gic.htm

Private Insurance Coverage

This state does not require private health insurance plans to cover cessation treatments. Cessation coverage in private health insurance plans varies by employer and/or plan. Smokers with this type of health insurance should contact their insurance plan for information on cessation benefits.

This state does not mandate cessation coverage for private insurance plans.

Quitline

Contact Information: 1-800-QUIT-NOW; http://makesmokinghistory.org/1-800-quitnow.html

Hours: 9 AM - 7 PM Monday-Thursday; 9 AM - 5 PM Friday; 8 AM - 6 PM Saturday; 8 AM - 8 PM Sunday

Eligibility to recieve counseling: Age; Readiness; for medication: Residents in selected communities with smoking prevalence higher than the state average.

Medications provided:

  • noNRT Gum
  • yesNRT Patch
  • noNRT Nasal Spray
  • noNRT Lozenge
  • noNRT Inhaler
  • noVarenicline (Chantix)
  • noBupropion (Zyban)

(Source: North American Quitline Consortium, www.naquitline.org)

American Lung Association Resources

The American Lung Association's Freedom from Smoking® program is widely available is community locations throughout the state of Massachusetts. Not On Tobacco is also offered in select locations. Additional options include Freedom From Smoking® Online, a program available 24/7 at http://www.ffsonline.org and the American Lung Association's Lung HelpLine (800-LUNG-USA). For further information, please call 781-890-4262 or visit us online at http://www.lung.org.