Recognizing that tobacco use remains a stubborn health problem in Tennessee and contributes to spiraling healthcare costs, TennCare now covers the price of smoking-cessation products, both over-the-counter and prescription, for all enrollees. The augmented benefit became effective July 1.

“That just goes along with Gov. Haslam’s commitment to encouraging healthy lifestyles and encouraging Tennesseans to be as healthy as they can,” said Kelly Gunderson, TennCare’s director of communications.

Enrollees under 21 always were covered when it came to products that help individuals kick the habit, thanks to the Early Periodic Screening, Diagnosis and Treatment program known as TENNderCare. Last October, pregnant women also were eligible for that benefit, based on a provision in the new federal health reform law.

Expanding the coverage to all TennCare enrollees carries a yearly price tag of a little more than $10 million, including $3.5 million in state dollars. The expectation is that the money will be returned in the form of reduced medical costs.

“The hope is that down the line it will lead to healthier individuals, healthier Tennesseans and healthier people on the TennCare program, but you can’t necessarily count on that happening,” Gunderson acknowledged. “You can just help people to take advantage of the benefit now. If it does lead to people having a healthier lifestyle, then, yes, it would have a beneficial cost impact on the program.”

Physicians and other providers are a critical component of this new benefit. Even if the smoking-cessation product is an over-the-counter one, physician authorization is still needed. A call to the pharmacy benefits manager will do. “That’s to ensure that an individual is not just relying on the drug, but is also going through a more comprehensive cessation program,” Gunderson explained.

TennCare enrollees using a smoking-cessation product must also be attending classes, receiving counseling or using the Tennessee Tobacco QuitLine at 1-800-QUIT-NOW. “We find that people have much higher success rates with quitting when they incorporate something else besides just the drug or a product,” she said.

The preferred products are over-the-counter generics and include nicotine patches, lozenges, gum and the like. If the patient uses a couple of those products without an effective result, then the physician may authorize name-brand products or even prescribe a medication such as Chantix or Zyban. The benefit is limited to 24 weeks in a year; for pregnant women, however, that benefit is extended.

To arrive at a dollar figure for the new benefit, Gunderson said TennCare’s pharmacy director relied on data from the American Lung Association (ALA) and MassHealth, the Massachusetts Medicaid program that shares many operational tenets with TennCare. According to the ALA, 22 percent of adults smoke.

Applying that percentage to the TennCare population, a conservative estimate is that about 103,400 TennCare enrollees are smokers. When MassHealth instituted a program to offer smoking-cessation products to all its beneficiaries, about 40 percent of the adult smokers in the program sought treatment. That equates to about 41,360 TennCare enrollees potentially taking advantage of the new benefit.

Yet, that number could be even higher — Gunderson said surveys show that between 70 and 80 percent of adult smokers want to quit.

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