Medicaid/Medicare Tobacco Cessation Benefits

Beginning Sept. 1, 2010, tobacco cessation medication and counseling became available to Kentucky Medicaid members. Dual-eligible members may be eligible to receive some of the available medicines to help them quit using tobacco.

All Medicaid recipients who are eligible can receive tobacco cessation benefits. Recipients enrolled in Passport should contact Passport Health Plan for the details of their tobacco cessation program.

A prescription is needed for all tobacco cessation medications. All medications, including over-the-counter nicotine replacement products require a prescription from a Licensed Kentucky Medicaid Provider, such as physicians, nurse practitioners, and physician assistants.

All FDA-approved medications are covered for two 90-day treatment regimens per year. Some products are not-preferred and will require review via the prior authorization process.

There is no copayment for these medications.

For additional information, contact Kentucky Medicaid Services at (502) 564-9444 or visit their website here.

Medicare provides coverage for smoking and other tobacco use counseling for participants who meet one of the following criteria:

• use tobacco and have a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use; or
• are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on Food and Drug Administration-approved information

Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four counseling sessions. The total annual benefit covers up to eight smoking and tobacco use cessation counseling sessions in a 12-month period.

Medicare's prescription drug benefit also covers smoking and tobacco use cessation agents prescribed by a physician.

For additional information about this benefit, visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227).

Follow this link to Kentucky's Medicaid Provider Directory to locate a provider near you.

These documents provide additional information to physicians regarding the Medicaid benefit to cover tobacco cessation.

Medicaid Provider Reference Guide

Medicaid Tobacco Cessation Pharmacotherapies Chart

What to tell your patients about smoking

Tobacco Cessation Referral Form