Medicaid Coverage

The Virginia Medicaid program covers:

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

NRT gum, patch, bupropion, and Chantix are covered by all plans. NRT lozenge, inhaler, and nasal spray coverage varies by plan. Individual and group counseling also varies by plan. Some plans only cover individual counseling for pregnant women. Coverage limitations, including prior authorization, step therapy, and copays all vary by plan.

For more information, please call the Virginia Department of Medical Assistance Services at 804-786-7933, or visit their website at http://www.dmas.virginia.gov/

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 Wellness Program for State Employees covers:

  • variesNicotine Gum
  • variesNicotine Patch
  • noNicotine Nasal Spray
  • variesNicotine Lozenge
  • variesNicotine Inhaler
  • variesVarenicline (Chantix)
  • variesBupropion (Zyban)
  • noGroup Counseling
  • variesIndividual Counseling
  • yesPhone Counseling
  • yesNo Tobacco Surcharge

NRT gum, patch, lozenge and bupropion are covered by all plans. NRT inhaler, nasal spray and Chantix coverage varies by plan. Phone and group counseling coverage also varies by plan. Some plans have annual limits on the number of quit attempts. All plans have duration limits, but have varying limits.

For more information, please call the Virginia Department of Human Resource Management Health Benefits Program at 804-225-3642 or 888-642-4414, or visit the Health Coverage website at http://www.dhrm.virginia.gov/healthcoverage

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; 1-877-777-6534; 1-866-QUIT-4-LIFE; 1-866-784-8454; http://www.quitnow.net/virginia

Hours: 7:00 AM - 3:00 AM Monday-Sunday

Eligibility to recieve counseling:

Medications provided:

  • noNicotine Gum
  • noNicotine Patch
  • noNicotine Nasal Spray
  • noNicotine 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® clinic program is available in limited locations in Virginia. Not On Tobacco is widely available in community locations throughout the state. 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 804-267-1900 or visit our website at http://www.lungva.org.