Medicaid Coverage

MOHealthnet covers:

  • yesNRT Gum
  • yesNRT Patch
  • yesNRT Nasal Spray
  • yesNRT Lozenge
  • yesNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • noGroup Counseling
  • yesIndividual Counseling
  • noQuitline

Medications are limited to 12 weeks per quit attempt. 1 individual counseling session with a health provider is covered per week. All medications require prior authorization. Only two quit attempts per person per lifetime are allowed.

For more information, please call the MOHealthnet Division at 888-275-5908, or visit their website at http://www.dss.mo.gov/fsd/msmed.htm

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 Missouri Consolidated Health Care Plan covers:

  • yesNRT Gum
  • yesNRT Patch
  • yesNRT Nasal Spray
  • yesNRT Lozenge
  • yesNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • yesIndividual Counseling
  • yesPhone Counseling
  • noNo Tobacco Surcharge

Nicotine replacement therapy patch, gum and lozenge as well as phone counseling is provided through the Next Steps program. This program lasts 8 weeks and members must receive phone counseling through it in order to receive NRT medications. Varenicline and bupropion are provided through regular pharmacy benefits, and counseling is not required to obtain these prescription medications. Individual counseling is provided through the Employee Assistance Program. State employees who are smokers are charged $25/month in extra health insurance premiums.

For more information, please call the Missouri Consolidated Health Care Plan at 800-487-0771, or visit their website at http://www.mchcp.org/

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://health.mo.gov/living/wellness/tobacco/smokingandtobacco/tobaccocontrol.php#quitline

Hours: 24 hours Monday-Sunday

Eligibility to recieve counseling: All tobacco users one call; multiple calls for Medicaid, uninsured, pregnant; for medication: WISEWOMAN participants referred by their WISEWOMAN provider via fax can receive 4 weeks of OTC NRT. All other tobacco users can receive a 2-week starter pack of OTC NRT (while funding lasts).

Medications provided:

  • yesNRT 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 throughout the state of Missouri. Not On Tobacco is offered in select high schools. Additional resources 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 more information about program locations and schedules, call 314-645-5505 or visit us at http://www.breathehealthy.org.