Medicaid Coverage

MassHealth covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • yesGroup Counseling
  • yesIndividual Counseling
  • yesQuitline

All 7 NRT and medications are covered. Group, individual and phone counseling are covered. Copayments of $1 are required for generic medications and $3.65 are required for brand name medications. Prior authorization is required for the NRT nasal spray and inhaler. There is an annual limit of two quit attempts per year and a duration limit of 90 days per quit attempt and a max of 16 counseling sessions per year. Step therapy varies by plan.

For more information, please call the MassHealth program at 617-573-1770 or 800-841-2900, or visit their website at http://www.mass.gov/eohhs/gov/departments/masshealth/

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. Coverage of tobacco cessation treatments may be different for higher-income Medicaid members enrolled in plans through the Massachusetts Health Connector. Patients in these plans should contact their insurance company to determine what is covered for them.

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:

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

All six MCOs cover all pharmacotherapy and all forms of cessation counseling. Duration limits, copay, and step therapy vary by plan.

For more information, please call the Massachusetts Group Insurance Commission at 617-727-2310, or visit their website at https://www.mass.gov/health-plans-for-active-state-employees

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; 1-800-943-8284; http://makesmokinghistory.org/1-800-quitnow.html

Hours: 9:00 AM - 7:00 PM Monday-Thursday; 9:00 AM - 5:00 PM Friday; 9:00 AM - 2:00 PM Saturday; closed Sunday

Eligibility to recieve counseling: No criteria to receive counseling. For medication: medical eligibility criteria, age 18+.

Medications provided:

  • noNicotine Gum
  • yesNicotine Patch
  • noNicotine Nasal Spray
  • noNicotine Lozenge
  • noNicotine 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.