Impact of Insurance Coverage on the Use and Effects of Smoking Cessation Medications
Leif I. Solberg
Tobacco use is not only the chief preventable cause of death, but it is also a very important contributor to the cause or complications of most chronic diseases. Therefore, facilitating smoking cessation should be very important to more effective disease management. Well-accepted, evidence-based guidelines describe effective clinical actions in support of smoking cessation; however, they are not followed as well as desired. This article focuses on the question of whether health insurance coverage for cessation medications (one of the effective actions) is important for their use and effectiveness. Although there have been accelerating calls from advocates for this coverage and a parallel increase in health plans and government programs providing such coverage, the evidence base is both recent and limited. Three major studies now suggest that coverage or cost sharing may only be effective when _combined with extraordinary efforts to ensure that smokers are aware of the benefit and can access it easily. However, it is unclear whether many payors are willing to do that. Chronic disease management programs should definitely be focusing on whatever they can do to encourage smoking cessation. There is good evidence that repeated advice and support (and pharmacotherapy) from a variety of healthcare professionals is effective, especially when it is combined with the other care that patients receive. Since few other patient behaviors contribute as much to the causes and complications of most chronic diseases, great emphasis should be placed on changing this one.
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