State Tobacco Cessation Coverage

Medicaid Coverage

The Rhode Island Medicaid program's coverage of cessation treatments varies by health plan:

NRT Gum
NRT Patch
NRT Nasal Spray
NRT Inhaler
NRT Lozenge
Varenicline (Chantix)

Bupropion (Zyban)
Group Counseling
Individual Counseling

RiteCare and Rhody Health Partners plans are required to cover NRTs. The fee-for-service plan does not cover medications. Counseling consists of 8 sessions lasting 30 minutes. Medications may be limited in duration. Prior authorization and co-payments may be required, and enrollment in counseling is required for medications.

For more information, please call the Rhode Island Department of Human Services at 401-784-8100 or 800-964-6211, or visit their website at http://www.dhs.state.ri.us/

View Medicaid Coverage Details

State Employee Health Plan Coverage

The Tobacco Cessation Program covers:

NRT Gum
NRT Patch
NRT Nasal Spray
NRT Inhaler
NRT Lozenge
Varenicline (Chantix)

Bupropion (Zyban)
Group Counseling
Individual Counseling
Phone Counseling

Counseling consists of 8 30-minute sessions and is available once per year. Co-payments are required.

For more information, please call the Rhode Island Office of Employee Benefits at 401-222-3160, or visit their website at http://www.employeebenefits.ri.gov/index.php

View State Employee Health Plan Coverage Details

Private Insurance Coverage

All private health insurance plans in Rhode Island are required to cover all cessation medications and cessation counseling when prescribed by a physician. Normal co-pays and deductibles may apply. This regulation is being implemented on a rolling basis in new insurance contracts with the state.

View State Mandates on Private Insurance Details

Quitline

The Try-To-STOP TOBACCO Resource Center of Rhode Island is open 9AM-10:30PM (M-TH), 6AM-5PM (F), 11AM-4PM (SAT) (Eastern Time). You can reach the Resource Center by calling 1-800-879-8678.

American Lung Association Resources

The American Lung Association of Rhode Island provides smoking cessation services statewide. 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 further information, please call 401-421-6487 or visit us online at http://www.lungri.org

Medicaid Data Sources

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?
NRT Gum	Varies	Multiple sources. See Additional Sources below.
NRT Patch	Varies	Multiple sources. See Additional Sources below.
NRT Nasal Spray	Varies	Multiple sources. See Additional Sources below.
NRT Lozenge	Varies	Multiple sources. See Additional Sources below.
NRT Inhaler	Varies	Multiple sources. See Additional Sources below.
Varenicline (Chantix)	Varies	Multiple sources. See Additional Sources below.
Bupropion (Zyban)	Varies	Multiple sources. See Additional Sources below.
Group Counseling	Yes	Multiple sources. See Additional Sources below.
Individual Counseling	Yes	Multiple sources. See Additional Sources below.

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Varies	Multiple sources. See Additional Sources below.
Lifetime limit on quit attempts	No
Annual limit on quit attempts	No
Prior authorization required	Varies	Multiple sources. See Additional Sources below.
Co-payments required	Varies	Multiple sources. See Additional Sources below.
Stepped-care therapy	No
Counseling Required for Medications	Yes	Multiple sources. See Additional Sources below.
Dollar Limit	No
Other

Additional Data Sources
Blue Cross Blue Shield of Rhode Island, Blue Chip for Ritecare, Member Handbook
Neighborhood Health Plan of RI, RITEcare Formulary, Drug Search
UnitedHealthcare - Ritecare, Provider Information for Generic Only Formulary Program
United Healthcare, Ritecare and Children with Special Healthcare Needs, Benefits Summary, January 2009
Neighborhood Health Plan of RI, Ritecare - Ancillary Benefits
RI Department of Human Services, Medical Assistance Program, March 2008, RIteCare Fact Sheet
R.I. Gen. Laws Â§ 27-18-66 (2008)
Correspondence with Rhode Island Department of Health
Rhode Island Department of Human Services, Provider Manual, Pharmacy Coverage Policy

State Employee Health Plan Data Sources

Type of Treatment	State Covers Treatment?	Data Source
MCO's Control Meds Coverage?
NRT Gum	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
NRT Patch	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
NRT Nasal Spray	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
NRT Lozenge	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
NRT Inhaler	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Varenicline (Chantix)	No	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Bupropion (Zyban)	No	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Group Counseling	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Individual Counseling	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Phone Counseling	No	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Online Counseling	No	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Quit Kit	No	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008

Type of Barrier	State Has Barrier?	Data Source
Limits on duration	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Lifetime limit on quit attempts	No
Annual limit on quit attempts	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Prior authorization required	No
Co-payments required	Yes	State of Rhode Island, Summary Plan Document, Active Employees PPO Plan, October 1, 2008
Stepped-care therapy	No
Counseling Required for Medications	No
Dollar Limit	No

Additional Data Sources
State of Rhode Island, State Employee Wellness Initiative, "Personal Toolbox of Wellness Initiatives"

Private Insurance Coverage Details

Type	Value	Data Source
Cessation mandate on the books	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Mandate applies to all insurance carriers	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Mandate applies to all populations	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
State mandates wellness program including smoking cessation	No
Other stipulations	No

Type	Value	Data Source
NRT Gum	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
NRT Patch	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
NRT Nasal Spray	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
NRT Lozenge	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
NRT Inhaler	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Varenicline (Chantix)	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Bupropion (Zyban)	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Group Counseling	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".
Individual Counseling	Yes	Officer of the Health Insurance Commissioner, Regulation 14, "Tobacco Cessation Treatment Coverage".

Additional Data Sources
HB 5823

Stop Smoking

Lung HelpLine

E-Newsletter

Rhode Island