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

NRT gum, patch, lozenge and bupropion are covered by all plans. NRT inhaler, nasal spray and Chantix are covered by some plans. Individual counseling is covered by all plans. Group and individual counseling are covered by some plans. All plans have duration limits and most have a limit of 70 cunseling visits per year. Annual limits on the number of quit attempts, prior authorization, copayments and step therapy all vary by plan.

For more information, please call the Consumer Service Center for Health Care Coverage at 866-550-4355, or visit their website at http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/

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

Members must enroll in the Get Healthy Program and receive phone or online counseling in order to receive medications. NRT gum, patch, bupropion and Chantix are covered. There is a duration limit of 168 days for bupropion and Chantix.

For more information, please call the Pennsylvania Employees Benefit Trust Fund at 717-561-4750 or 800-522-7279, or visit their website at https://www.pebtf.org/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; 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.