Medicaid Coverage

The North Carolina Medicaid program covers:

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

All seven pharmacotherapy treatments and medications are covered. Individual and phone counseling are covered. Group counseling is not covered. There is a duration limit of six months for Chantix. Step therapy is required for the inhaler and nasal spray. There is a $3 copay for prescriptions.

For more information, please call the North Carolina Division of Medical Assistance at 919-855-4400 or 800-662-7030, or visit their website at https://dma.ncdhhs.gov/medicaid

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 State Health Plan for Teachers and State Employees covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • noGroup Counseling
  • yesIndividual Counseling
  • noPhone Counseling
  • noNo Tobacco Surcharge

All seven pharmacotherapies and medications are covered. Individual counseling is covered. The duration limit for cessation treatments vary by plan.

For more information, please call the North Carolina State Health Plan at 1-888-234-2416, or visit their Web site at https://shp.nctreasurer.com/Pages/Default.aspx

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://www.quitlinenc.com/

Hours: 24 hours, Monday-Sunday

Eligibility to recieve counseling: Any North Carolina resident. Uninsured residents, Medicaid and Medicare insured residents will receive up to 4 proactive coaching sessions. All commericially insured residents will be limited to one coaching session. For medication: member of State Health Plan for Teachers and State Employees, Medicaid insured or uninsured enrolled in multicall program; 18 years of age and older.

Medications provided:

  • yesNicotine 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® and Not On Tobacco programs are widely available in locations throughout North Carolina. 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 919-832-8326 or visit our website at http://www.lungnc.org.