Cessation Treatment Coverage

The cessation treatment coverage criteria used in the American Lung Association’s State of Tobacco Control 2012 report are based on the coverage of tobacco cessation treatments provided by the federal government through its four main public insurance programs: 1) Medicare (for Americans over age 65), 2) Medicaid (for low-income and/or disabled Americans), 3) TRICARE (for members of the military and their families), and 4) Federal Employee Health Benefits Program (for federal employees and their families). Providing help to quit through these programs will reach large numbers of tobacco users, improve health, prevent unnecessary death, save taxpayer money, and set an example for other health plans. The federal government must lead by example and cover a comprehensive benefit to everyone to whom it provides health care.

The definition of a comprehensive tobacco cessation benefit used in these criteria follows the recommendations in the Clinical Practice Guideline entitled Treating Tobacco Use and Dependence. In this Guideline, the U.S. Public Health Service recommends the use of 7 medications and 3 types of counseling as effective for helping tobacco users quit.

The cessation coverage grade breaks down as follows:

Grade	Points Earned
A	14 to 16 Total Points
B	13 Total Points
C	11 to 12 Total Points
D	10 Total Points
F	Under 10 Total Points

Medicare (4 points)
Target is all Medicare recipients have easy access to a comprehensive cessation benefit.

+4 points: All Guideline-recommended medications and counseling are covered
+3 points: At least 4 medications and 1 type of counseling are covered
+2 points:At least 2 medications and 1 type of counseling are covered
+1 points: At least 1 treatment is covered
+0 points: No coverage

Medicaid (4 points)
Target is all Medicaid enrollees have easy access to a comprehensive cessation benefit.

+4 points: All Guideline-recommended medications and counseling are covered
+3 points: At least 4 medications and 1 type of counseling are covered
+2 points:At least 2 medications and 1 type of counseling are covered
+1 points: At least 1 treatment is covered
+0 points: No coverage

TRICARE (4 points)
Target is all TRICARE enrollees have easy access to a comprehensive cessation benefit.

+4 points: All Guideline-recommended medications and counseling are covered
+3 points: At least 4 medications and 1 type of counseling are covered
+2 points:At least 2 medications and 1 type of counseling are covered
+1 points: At least 1 treatment is covered
+0 points: No coverage

Federal Employee Health Benefits (FEHB) (4 points)
Target is all federal employees & dependents have easy access to a comprehensive cessation benefit.

+4 points: All Guideline-recommended medications and counseling are covered
+3 points: At least 4 medications and 1 type of counseling are covered
+2 points:At least 2 medications and 1 type of counseling are covered
+1 points: At least 1 treatment is covered
+0 points: No coverage

Bonus Points: 1 bonus point in each category is awarded if coverage is provided with minimal barriers to access.