Medicaid Coverage

The Ohio Medicaid program covers:

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

All seven medications are covered. Individual, group and phone counseling are covered. Coverage limitations, such as limits on duration and quit attempts per year, prior authorization and step therapy, varies by plan. All plans have quantity limits for at least some of the covered pharmacotherapy.

For more information, please call the Ohio Medicaid Office at 800-324-8680, or visit their website at http://medicaid.ohio.gov/

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

All plans offer Take Charge, Live Well though APS Health Care, which covers:

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

NRT gum, patch, bupropion and Chantix are covered. Individual and group counseling coverage varies by plan. Phone counseling is covered by all plans. There is an annual limit of two quit attempts per year and a duration limit of 12 weeks for the NRT gum, patch and Chantix. Prior authorization is required for Chantix. Copayments are waived if patients work with a health coach to receive counseling.

For more information, please call the Ohio Department of Administrative Services at 614-466-8857 or 800-409-1205, or visit their website at http://www.das.ohio.gov/Divisions/Human-Resources/Benefits-Administration/Medical

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; 1-800-934-4840; http://www.ohioquits.com/

Hours: 9:00 AM - 12:00 AM Monday-Thursday; 9:00 AM - 10:00 PM Friday; 10:00 AM - 6:30 PM Saturday and Sunday

Eligibility to recieve counseling: Uninsured, Medicaid recipients, pregnant women or members who have signed on to pay through the Ohio Tobacco Collaborative. For medication: caller must be willing to enroll in the quitline counseling program and make a quit attempt in the next 30 days; must be 18 years of age or older; must not be pregnant; must not have medical contraindications such as cardiovascular disease, etc.

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 available in community locations throughout Ohio. Not On Tobacco is offered in the Columbus area. 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 for FFS and N-O-T, call 1-800-LUNGUSA, or visit our website at http://www.midlandlung.org.