The vision of the program is to successfully reach out to a population of ethnically diverse, low income patients in the primary care setting at AUCH member community health centers and offer culturally sensitive, affordable, and effective tobacco cessation treatment.
Among underserved populations, the burden of tobacco is substantial. The National Tobacco Prevention Network has established a clear association between poverty and high rates of tobacco use. Smoking is more prevalent among the uninsured than those with insurance. This program is designed to help those patients who are uninsured and traditionally may have limited access to tobacco cessation programs and who receive their primary healthcare from one of Utah’s Community Health Centers (CHCs).
Not providing cessation counseling is a missed opportunity in underserved patients. Tobacco counseling, including simple advice to quit, has been shown effective in primary care. Smoking cessation interventions have proven successful among low-income and minority patients, especially when tailored to these populations. Since disadvantaged patients, including 63% of the uninsured, are commonly seen in primary care settings, primary care providers are in a unique position to impact tobacco use in underserved patients.
By ensuring access to proven tobacco-cessation methods, AUCH and the State of Utah are working to mitigate the impact these populations place on publicly funded entities as a result of smoking-related diseases. AUCH TCP is funded by a yearly grant from Utah Department of Health Tobacco Prevention and Control Program.
Topics
Pharmacotherapy Information for Quit Meds
- Medicaid, Primary Care Network (PCN), and Medicare Tobacco Cessation Benefits
- Utah Medicaid Billing Codes
- Medicare Benefits
- Utah Insurance Plan Benefits for Tobacco Cessation
- Recommended Tobacco Cessation Links
- An AUCH Member Provider should positively urge patients who use tobacco to quit at every visit. Quite often the effects of tobacco use are related to the condition that is being treated.
- If the patient expresses a desire to quit using tobacco, the provider informs the patient that if they are uninsured, they can receive their quit medication free of charge through the AUCH Tobacco Cessation Program.
- All patients, whether insured or not, are eligible for free Quit Line counseling services. Counseling services should be offered to every patient who has expressed a desire to quit.
- The provider or Medical Assistant can quickly and easily sign the patient up for Quit Line counseling through the online referral form at http://www.nationaljewish.org/utah-referral/
- Why Counseling Should be Offered
a) Counseling has been proven to greatly increase the success rate of quit attempts.
b) The Quit Line counselors provide patients with:
i) A personal plan for quitting, developed by the patient and his/her quit coach
ii) An assessment of what the patient needs to quit using tobacco
iii) Up to 5 free counseling sessions
iv) Connections to resources such as health plans or programs within the patient’s area
v) A quit kit to walk the patient through the quitting process step-by-step
vi) Nicotine Replacement Therapy gum provided free of charge to all participants
vii) Nicotine patches provided free of charge to uninsured patients.
- Regarding prescription quit medications, the provider will determine whether the patient is a good candidate for Chantix or needs or if he/she needs to utilize Bupropion instead. As stated previously these medications are free to patients who are uninsured. Please note: Providers at locations served by Smith’s Pharmacies must put TCP in the notes field of the ePrescription or write TCP in large block letters on the paper prescription, otherwise the patient will NOT receive their medication free of charge!
- Patients who are insured will be able to make a choice at the pharmacy point of sale between their insurance co pay and the AUCH program cash price, whichever is less expensive.
- Nicotine replacement products are available through the AUCH Plan at the pharmacy for patients who are not good candidates for the prescription medications. Please note: Providers must write a prescription for these over the counter items or patients will not receive the AUCH PSP discount.
Guidelines for Prescribing Quit Meds
- Patients using Chantix to quit can receive up to 9 months of treatment.
- Because it is an antidepressant, Bupropion can only be prescribed for three months within a one year period. The patient can utilize nicotine trans-dermal patches, nicotine gum, or nicotine spray if they want to continue treatment during the following nine months until they are once again eligible to utilize the antidepressant medication.
- Note to providers regarding interrupted treatment period: If a patient is not compliant, does not pick up their Bupropion refills in time, and continuous treatment is interrupted please take note of when the patient will be eligible for another quit attempt based on three month per year eligibility stated above. Regarding Chantix®, the patient can be encouraged to start up treatment again as soon as possible.
- The patient can still use Quit Line and Quit Net in between quit attempts as well as during their quitting effort.
Chantix is targeted specifically toward smoking cessation and has been proven quite effective in blocking the pleasure receptors stimulated by tobacco. However, in June of 2009 a Black Box warning was issued regarding Chantix which highlighted the risk of serious mental health events including changes in behavior, depressed mood, hostility, and suicidal thoughts when taking it.
Recommendations and Considerations for Healthcare Professionals
- It is important to discuss the possibility of serious neuropsychiatric symptoms in the context of the benefits of quitting smoking with patients before prescribing these medications. Varenicline and bupropion are both effective smoking cessation aids and the health benefits of smoking cessation are immediate and substantial.
- Healthcare professional should monitor all patients taking varenicline and bupropion for serious neuropsychiatric symptoms. These symptoms include changes in behavior, hostility, agitation, depressed mood, suicidal ideation, suicidal behavior and attempted suicide. These symptoms have occurred in patients without pre-existing psychiatric illness and have worsened in some patients with pre-existing psychiatric illness. In most cases, neuropsychiatric symptoms developed during treatment with varenicline or bupropion but in others, symptoms developed after stopping drug treatment.
- Patients should be informed that it is not unusual to have symptoms such as irritability, feeling anxious, depressed mood and trouble sleeping when they are withdrawing from nicotine, independent of whether they are taking varenicline or bupropion.
- Patients with serious psychiatric illness such as schizophrenia, bipolar disorder, and major depressive disorder, may experience worsening of their pre-existing psychiatric illness while taking varenicline or bupropion.
- Patients who discontinue treatment because of neuropsychiatric events should continue to be monitored until symptoms resolve. Although symptoms resolved after treatment was stopped in many cases, there were also some cases where the symptoms persisted.
Information for healthcare professionals to discuss with patients, family members, and caregivers:
- Quitting smoking can decrease the chances of lung and heart disease and getting cancer. These important health benefits should be weighed against the small, but real, risk of serious adverse events with use of varenicline or bupropion.
- Worsening or recurrence of psychiatric illness. Patients should be told that some patients taking varenicline or bupropion have experienced worsening of their psychiatric illness, even when the illness was under control and some patients have experienced a recurrence of a previous psychiatric illness when taking these drugs for smoking cessation.
- Unusual changes in mood and behavior. Patients should be instructed to contact their healthcare provider immediately if they observe or develop thoughts about suicide or attempting suicide, feel agitated, aggressive or violent and other unusual changes in mood or behavior.
- Some symptoms are to be expected when quitting smoking. Patients should be told that it is not unusual to have symptoms such as irritability, feeling anxious, depressed mood and trouble sleeping when they are withdrawing from nicotine, independent of whether they are taking varenicline or bupropion and that vivid, unusual, or strange dreams may occur while taking Chantix and are not a cause for alarm.
Discuss other methods of quitting smoking if it is decided that varenicline or bupropion are not the best treatment option
- The generic drug, Bupropion Hydrochloride was initially released under the brand names Zyban® and Wellbutrin® . While not as effective for tobacco cessation as Chantix, Bupropion can lessen discomforts associated with nicotine withdrawal making the quit attempt more manageable for people who haven't been able to successfully quit smoking using nicotine replacement alone.
- Patients with depression or other mental illnesses often think about or attempt suicide. Providers need to closely watch anyone taking antidepressants, especially early in treatment or when the dose is changed. Patients who become irritable or anxious, or have new or increased thoughts of suicide or other changes in mood or behavior (or their care givers) should contact their healthcare professional right away.
Children
Taking antidepressants may increase suicidal thoughts and actions in about 1 out of 50 people 18 years or younger. Although Bupropion is prescribed for children, FDA has not approved Bupropion for use in children.
Adults
Several recent scientific publications report the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications. Even before these reports became available, FDA began a complete review of all available data to determine whether there is an increased risk of suicidal thinking or behavior in adults being treated with antidepressant medications. It is expected that this review will take a year or longer to complete. In the meantime, FDA is highlighting that adults being treated with antidepressant medication, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.
PACT (Professional Assisted Cessation Therapy) an independent consortium of leader in the treatment of tobacco dependence developed a comprehensive healthcare practitioner’s guide regarding Reimbursement for Smoking Cessation Therapy.
Medicaid, Primary Care Network (PCN), and Medicare Tobacco Cessation Benefits
Cessation Counseling and Support
All Medicaid and PCN enrollees are eligible for intensive cessation counseling through the Utah Tobacco Quit Line (1-888-567-TRUTH). Intensive counseling includes up to five sessions lasting 40 minutes each. Up to eight weeks of nicotine replacement therapy (patch or gum) is available to those enrolled in this intensive counseling program.
Cessation Medications
To view the medication benefits for Medicaid and PCN clients go to: http://www.tobaccofreeutah.org/medpcnbenefits.pdf (PDF 2.75 MB).
Terms matched: 1 - Score: 7 - 12 Mar 2009 - URL: http://health.utah.gov/medicaid/manuals/pdfs/Medicaid%20Information%20Bulletins/Traditional%20Medicaid%20Program/2000/April2000-MIB.pdf
As of November 2010 Tobacco abuse counseling and therapy is a non-covered service for physician services:
http://health.utah.gov/medicaid/manuals/pdfs/Medicaid%20Provider%20Manuals/Non-Traditional%20Medicaid%20(NTM)/NTM-manual11-10.pdf
This is unfortunate considering that in Utah, the annual direct costs to the economy attributable to smoking are in excess of $1.1 billion, including workplace productivity losses of $ 337 million, premature death losses of$353 million, and direct medical expenditures of $448 million. In fact, some of the highest rates of smoking are found among people enrolled in Medicaid. A recent study by American Lung Association of Utah found that if Utah were to invest in comprehensive smoking cessation benefits, Utah would receive, on average, a return of $1.22 for every dollar spent on helping smokers quit. The study derived these economic benefits by considering lower medical costs due to fewer people smoking, increased productivity in the workplace and reduced absenteeism and premature death due to smoking.
Cessation Counseling and Support
Smoking cessation (non medication) falls under Medicare Part B (medical). Cessation is covered if a doctor orders it. It covers counseling for counseling for two attempts during a 12-month period IF the person is diagnosed with a smoking-related illness or is taking medication that may be affected by tobacco use. Counseling for each attempt includes up to four face-to-face visits.
Co-insurance (usually 20%) and Part B deductible may apply.
Cessation Medications
Any medication that Medicare covers would be under Medicare Part D. There are ~54 Part D plans, and a person must have one of the plans that covers cessation medication.
Billing Codes for Tobacco Cessation Counseling for Medicare Patients
MM5878 – Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5878.pdf
Utah Insurance Plan Benefits for Tobacco Cessation
CIGNA
Nicotine Replacement Therapy
Patch- 50% off of 8 week supply of Habitrol patches, with accompanying self-help guide and CD.
For more information, see the CIGNA Healthy Rewards discount amenity program at: www.mycigna.com
Cessation Counseling and Support
Support 35% off of Quitnet® online tobacco cessation program. For more information, see the CIGNA Healthy Rewards discount amenity program at: www.mycigna.com
Select Health
Nicotine Replacement Therapy
Patch- Fully covered, but only when provided by Free & Clear.No co-pay or prescription required.
Prescription Medications
Zyban covered for up to 3 months. Prescription & co-pay required. CHANTIX covered for up to 6 months. Prescription and co-pay required.
Cessation Counseling and Support
Free & Clear telephone counseling is fully covered. Patients may self-refer by calling 1-866-784-8454
Public Employees Health Program- (PEHP)
Nicotine Replacement Therapy
- Patch and Gum- Fully covered when provided by the Utah Tobacco Quit Line. May self-refer by calling: 1-888-567-TRUTH (8788) No co-pay or prescription required.
- Nasal Spray- Nicotrol Nasal Spray covered for up to 3 months. Prescription & co-pay required.
- Inhaler- Nicotrol Inhaler covered forup to 3 months. Prescription & co-pay required.
*All prescriptions are subject to the pharmacy deductible
Prescription Medications
Bupropion-Prescription & co-pay required. *All prescriptions are subject to the pharmacy deductible
CHANTIX- Available for 3 months without a prior authorization but may be dispensed up to 6 months with a prior authorization. Prescription & co-pay required. *All prescriptions are subject to the pharmacy deductible.
Cessation Counseling and Support
One-on-one telephone support through the Utah Tobacco Quit Line is fully covered. May self-refer by calling: 1-888-567-TRUTH (8788)
Healthy Utah Benefits - Up to $100 rebate incentive for quitting. Contact Healthy Utah for details: 1-801-538-6261 or 1-888-222-2542 or by email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Regence Blue Cross Blue Shield
Patients will need to call the customer service number on the back of their membership card to
determine the benefits offered by their plan.
United Healthcare
"Quit Power" tobacco cessation program. Patients will need to check with customer service or look at information on www.myuhc.com for availability.
A Smoking Cessation toolkit is available to all fully insured employers for use in an onsite smoking cessation program. The toolkit includes educational material, tobacco cessation health discount information, a resource guide, nicotine replacement therapy chart and a tobacco cessation tracker.
Recommended Tobacco Cessation Links
