Medicaid Coverage

Coverage for cessation treatments varies completely by plan:

  • yesNicotine Gum
  • yesNicotine Patch
  • variesNicotine Nasal Spray
  • yesNicotine Lozenge
  • variesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • variesIndividual Counseling
  • variesQuitline

The NRT gum, patch, lozenge, bupropion and Chantix are covered by all plans. NRT inhaler and nasal spray coverage varies by plan. Individual, group and phone counseling coverage varies by plan. Coverage limitations, such as limits on duration and annual quit attempts, prior authorization, counseling requirements, copay, and daily quantity limits varies by plan.

For more information, please call the New Mexico Medical Assistance Division at 888-987-2583, or visit their website at http://www.hsd.state.nm.us/mad/

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.

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 Smoking Cessation Benefit covers:

  • noNicotine Gum
  • noNicotine Patch
  • noNicotine Nasal Spray
  • noNicotine Lozenge
  • noNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • noGroup Counseling
  • variesIndividual Counseling
  • variesPhone Counseling
  • yesNo Tobacco Surcharge

All seven pharmacotherapies and medications are covered. Individual and phone counseling are covered. There is a duration limit of eight weeks or two 90-day courses of treatment. Members are required to pay 50% coinsurance after deductible is met.

For more information, please call the Administrative Office at 505-244-6000 or 855-618-1800, or visit their website at https://www.mybenefitsnm.com/

Private Insurance Coverage

All private health insurance plan that offer maternity benefits are required to cover smoking cessation treatment. This treatment is defined as: (1) Diagnostic services; (2) Two 90-day courses of prescription medications per year; and (3) Individual or group counseling. These benefits can be subject to normal co-payments and deductibles. The law does not require coverage of over-the-counter medications (NRT gum and lozenge).

Quitline

Contact Information: 1-800-QUIT-NOW; http://www.quitnownm.com/

Hours: 24 hours, Monday-Sunday

Eligibility to recieve counseling: Services available to youth (age 13 and older) adult tobacco users, family and friends of tobacco users and health care providers, must be ready to quit in next 30 days. For medication: must be age 18 or older, ready to quit within 30 days, participating in counseling and have no contraindications for nicotine replacement therapy..

Medications provided:

  • yesNicotine Gum
  • yesNicotine Patch
  • noNicotine Nasal Spray
  • yesNicotine 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 throughout the state of New Mexico. Not On Tobacco is offered in select cities. 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 more information about program locations and schedules, call 505-265-0732 or visit us online at http://www.lung.org