Are exchange insurers failing to adequately cover mandated tobacco cessation at no cost-sharing, or just not explicitly highlighting the benefits?
Less than 20 percent of Affordable Care Act marketplace plans appear to be fulling covering tools and medications to quit smoking at no cost for members, according to a new analysis by the American Lung Association.
"State marketplaces are falling woefully short of helping millions of Americans quit smoking," said Harold Wimmer, CEO of the American Lung Association. "Evidence suggests that smoking rates of people enrolled in marketplace plans are high, which means there's a unique opportunity to help millions quit."
Only 60 exchange plan issuers out of 348 (17 percent) listed all the FDA-approved and Preventive Services Task Force-recommended tobacco cessation medications and therapies without any cost-sharing, as required by the ACA and federal essential health benefit regulations. In only one state, West Virginia, were all plans in the marketplace (from one insurer, Highmark Blue Cross) noting coverage for all the tobacco cessation medications, the ALA found.
Trying to reduce the harm and costs of smoking, the ACA and its regulations require that all health plans cover a comprehensive tobacco cessation benefit, without cost-sharing or prior authorization. That includes at least two quit attempts per year, four sessions of cessation counseling, and all FDA-approved cessation medications (nicotine patches, gums, lozenges, nasal sprays and inhalers, and the drugs bupropion and varenicline).
Based on the formulary information online for the exchange plans, the ALA concluded that coverage in the "vast majority of state marketplace plans is not consistent with federal requirements in terms of covering all seven tobacco cessation medications." Compliance "was marginally higher" in state-run marketplaces than in federally-facilitated marketplaces, according to the study.
Overall, 63 issuers (18 percent) listed all seven tobacco cessation medications and noted that none of them had cost-sharing, the group found. In federally-facilitated exchanges, 44 issuers (17.5 percent) indicated coverage for all seven tobacco cessation medications without cost-sharing, and in the state-run HIXs, 19 issuers (19 percent) indicated coverage for all seven tobacco cessation medications without cost-sharing.
Of the 252 insurers selling plans in federally-facilitated marketplaces, 101 (40 percent) listed all seven tobacco cessation medications as covered on formularies--but without mentioning the no-cost benefit--and of the 96 issuers selling plans in state-run exchanges, 43 (44 percent) listed all seven tobacco cessation medications.
While many or most of insurers could actually be covering the comprehensive benefit in compliance, with no cost sharing, without explicitly stating so in the exchanges, the American Lung Association is calling on insurers, states and the feds to review the discrepancies going forward.
"Quitting is hard," Wimmer said. "Federal and state policy makers must make sure insurance plans are covering a comprehensive cessation benefit with no-cost sharing. Not only will it save lives, but it is also the law."