Few tobacco users have comprehensive tobacco cessation benefits, and insurers lack awareness about the benefits of tobacco cessation interventions and the return on investment of such programs. Coverage is inconsistent across plans, and barriers to benefit use remain even where coverage exists. The reasons why coverage is limited are complex. They range from inconsistent diagnostic and procedural coding and inconsistent reimbursement for like-coded services, to the lack of awareness of existing benefits among providers and plan members, to the variety of insurers across the nation. The Insurance and Reimbursement task group concluded that clinicians have not had sufficient incentives from insurers to treat tobacco use consistently, and agreed on four objectives for future action.

Recommended Actions:

• Collaborate with stakeholders to influence all insurers to offer comprehensive cessation benefits to all members/employees.
• Facilitate selection by states of “best fit” effective, evidence-based cessation programs through case studies and models of stakeholder collaboration and coordination across systems.
• Improve reimbursement for all evidence-based tobacco cessation services delivered by qualified providers.
• As a short-term strategy, develop a mechanism for sharing members’ successes with Medicaid reimbursement for quitlines and pharmacotherapy.