Medicaid Coverage

The Oregon Health Plan covers:

  • variesNRT Gum
  • yesNRT Patch
  • variesNRT Nasal Spray
  • variesNRT Lozenge
  • variesNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • yesIndividual Counseling
  • yesQuitline
  • yesSubmitted Section 2502 SPA?

Fee for service members have access to all treatments. Managed care plan members have access to most treatments, and should contact their plans. Co-payments vary by plan and fee for service members must pay $3 copays for varenicline.

For more information, please call the Oregon Health Plan Office at 503-945-5772, or visit their website at http://www.oregon.gov/DHS/healthplan/index.shtml

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 Public Employees Benefit Board covers:

  • yesNRT Gum
  • yesNRT Patch
  • noNRT Nasal Spray
  • noNRT Lozenge
  • noNRT Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • noGroup Counseling
  • noIndividual Counseling
  • yesPhone Counseling
  • yesOnline Counseling
  • noNo Tobacco Surcharge

Co-payments of $1-5 are required for varenicline and bupropion, depending on health plan. Patients receive medications through the Quit for Life phone counseling program. Please visit www.quitnow.net/PEBB/Default.aspx to enroll.

For more information, please call the Oregon Public Employees' Benefit Board at 503-373-1102 or 800-788-0520, or visit their website at http://oregon.gov/DAS/PEBB/

Private Insurance Coverage

Beginning January 1, 2010, insurance plans are required to cover a physician-recommended tobacco cessation program for all members 15-years old or older. Plans are required to provide at least $500 of coverage for such programs, and they are to include educational and medical treatment components.

Quitline

Contact Information: 1-800-QUIT-NOW; http://www.oregonquitline.org/

Hours: 4 AM - 12 AM Monday-Saturday; 4 AM - 5 PM Sunday

Eligibility to recieve counseling: Multiple calls only: Uninsured; Insured (Medicaid - Oregon Health Plan "Open Card" and CAREAssist) Single call only: Insured (private insurance); for medication: Age 18+, no medical contraindications

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 in Oregon offers Freedom From Smoking classes in some areas of the state. Some Oregon high schools also offer N-O-T On Tobacco, the teen tobacco cessation program. For more information, please contact healthinfo@lungoregon.org or 866-661-5864.