Medicaid Coverage

The Pennsylvania Medicaid program covers:

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

Prior authorization may be required for some plans. Some plans have duration and annual limits. Copays apply to some plans. Step therapy is only required in one plan. For plans that cover counseling, counseling is also limited to 70 days of counseling per year.

For more information, please call the Office of Medical Assistance Programs at 717-787-1870, or visit their website at http://www.dpw.state.pa.us/OMAP/

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 Pennsylvania Employee Benefits Trust Fund covers:

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

Patients must enroll in the Get Healthy Program in order to receive medications. To enroll, call 1-8866-908-9440 or go to http://www.pebtf.org.

For more information, please call the Pennsylvania Employees Benefit Trust Fund at 717-561-4750 or 800-522-7279, or visit their website at http://www.pebtf.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; 1-877-724-1090; http://www.health.pa.gov/my%20health/healthy%20living/smoke%20free%20tobacco/pages/pa-free-quitline.aspx#.vjem-jjd99a

Hours: 7:00 AM - 1:00 AM Monday, Wednesday-Saturday; 8:00 AM - 1:00 AM Tuesday; 7:00 AM - 8:00 AM Sunday

Eligibility to recieve counseling: Readiness; age (14 years and older); resident of Pennsylvania. For medication: age (18 years and older); complete medical screening questions.

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 in community locations throughout Pennsylvania. In addition, Not On Tobacco is offered in select high schools. 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 1-800-LUNGUSA, or visit http://www.lunginfo.org.