Medicaid Coverage

The Texas Medicaid program covers:

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

All pharmacotherapy and phone counseling are covered by all plans. Group and individual counseling coverage varies by plan. Duration limits and annual limits vary by plan. Prior authorization and step therapy is required for the inhaler and nasal spray for all plans.

For more information, please call the Texas Medicaid Contact Center at 800-925-9126, or visit their website at https://hhs.texas.gov/services/health/medicaid-chip

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 Group Benefits Program covers:

  • yesNicotine Gum
  • yesNicotine Patch
  • yesNicotine Nasal Spray
  • yesNicotine Lozenge
  • yesNicotine Inhaler
  • yesVarenicline (Chantix)
  • yesBupropion (Zyban)
  • variesGroup Counseling
  • noIndividual Counseling
  • variesPhone Counseling
  • noNo Tobacco Surcharge

Bupropion and varenicline are covered by all plans. NRT gum, patch, lozenge, inhaler and nasal spray coverage varies by plan. Phone and group counseling coverage varies by plan. Coverage limitations, such as limits on duration and annual quit attempts and step therapy, vary by plan.

For more information, please call the Employee Retirement System of Texas at 877-275-4377, or visit their website at https://www.ers.texas.gov/

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: 1-877 937-7848; http://www.dshs.state.tyes.us/tobacco/quityes.shtm

Hours: 24 hours, Monday-Sunday

Eligibility to recieve counseling: 13 years of age or older; readiness to quit. For medication: living in comprehensive program area, by health care provider fax referral, uninsured, pregnant women.

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 available in limited locations in Texas. Not On Tobacco is offered in select high schools in Texas. 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 512-467-6753 or visit us online at http://www.texaslung.org.