Tobacco Cessation Benefits Coverage
Background
Tobacco cessation benefits are an important addition to public and private health plan services. Tobacco cessation services and treatments refer to the range of resources available to help smokers quit their addiction. In a survey conducted in 2004, of the 27 million smokers in the United States, 70% reported wanting to quit smoking completely (5). With nearly 65% of Americans receiving health coverage through their work, employers play a strategic role in tobacco cessation (9). When opting for health care coverage, purchasers can assist employees who want to quit by ensuring that tobacco cessation benefits are standard and promoted through their health plans (3).
Employees who smoke cost employers an additional $3,000 per year in increased absenteeism, reduced productivity, and increased insurance rates. On average, smokers are absent from work 50% more often than nonsmokers (1). Nationwide, decreased productivity resulting from tobacco use cumulates to nearly $82 billion each year (4). Employees who smoke also increase insurance costs to their employers. Compared to nonsmokers, men who smoke incur $16,000 more in lifetime medical expenses; women incur $18,000 more. In the United States, these medical health care expenditures total over $75 billion each year (4). Smoking is also a known risk factor for asthma, diabetes, lung disease and childbirth complications (8). Although these health conditions may not be entirely preventable, the severity of the condition and associated costs may be reduced with smoking cessation treatment.
Tobacco cessation treatment in health plans is cost-effective in relation to other medical interventions associated with chronic conditions attributable to tobacco use (7). Providing comprehensive tobacco cessation benefits costs employers between 10 and 40 cents per month for each member covered (5). According to the Tobacco-Free Coalition of Oregon, the medical cost of an average heart attack is $23,234. The equivalent amount could provide a business one year's worth of tobacco cessation benefits for 6,454 employees and dependents (8).
Effective programs and tools for tobacco cessation include physician intervention, pharmacotherapy, counseling, and reduced out-of-pocket expense. Physicians often suggest pharmacotherapies and counseling resources in conjunction for their proven ability to increase smoking cessation rates (9). Some smokers choose telephone quit lines that provide supportive services to stop tobacco use. Reduced out-of-pocket expenses and limited co-payments further encourage tobacco cessation by making treatments more financially possible.
Employers have many options in health care coverage, and may select health plans that include tobacco cessation benefits. With the added coverage, businesses can increase both the number of smokers attempting to quit and the percentage that successfully quit (5).
Policies
Health plans voluntarily cover comprehensive tobacco cessation benefits.
The Centers for Disease Control and Prevention (CDC) recommends all HMOs and health plans include cessation benefits in their coverage to provide counseling sessions and both prescription and over-the-counter medication (5).
Suggested model policies for tobacco cessation programs can be found at the Center for Tobacco Cessation http://ctcinfo.org
- Recently, 71% of state Medicaid programs voluntarily extended coverage to offer at least one form of tobacco-use treatment for all recipients (6). Coverage includes tobacco-dependence counseling or medication, and pharmacotherapy in some states. Medicaid is the nationwide public provider for health coverage to low-income families, and its cessation benefit services may be recommended to other health organizations for application.
- Chevron, a company with 37,000 employees, won the C. Everett Koop Award for worksite health promotion primarily focused on tobacco cessation. The company learned that its total expenditures on tobacco-related illness amounted to $4 million annually - more than any other risk factor (11). Chevron decided to adapt a comprehensive smoking cessation program that includes smoking policies and smoke-free workplaces, group and self-help smoking cessation programs, partnerships with health plans around smoking cessation and a performance standard for smoking cessation counseling.
For employers and large purchasers, requiring a health plan to provide cessation benefits becomes a unique opportunity to assist employees in their attempts to quit smoking.
- In 1994, the Pacific Business Group on Health Negotiating Alliance required all of its health plans to provide smoking cessation medication. After evaluating the magnitude of tobacco use and its health problems, the coalition expanded the benefit to cover a more comprehensive cessation package including counseling.
- The Smoke-free Workplace Law implementation in 2002 left many ESCO Corporation employees disgruntled. Previously, about one-third of the steel manufacturer's workforce smoked on the job, even at workstations with cigarettes in their mouths (11). Enactment of the new law forced workers to smoke in designated outdoor areas. As tobacco use largely affected many of its workers, ESCO decided to offer health plan options for in-person or telephone tobacco cessation counseling and medication. Gifts and financial incentives presented by the company also encouraged smokers to quit. ESCO maintains, "The standard cost benefit analysis reveals that cessation is a good strategy even if only one smoker successfully quits" (8).
Purchasers should recommend public telephone quit lines.
Tobacco telephone quit lines deliver private one-on-one counseling and assistance at no cost. Quit line counselors listen and collaborate with the caller to discuss a plan for tobacco cessation that caters to the smoker's individual needs. Quit line counseling increases the chance of long-term abstinence by about 30% (10). In comparison to self-help materials, quit lines are more effective in promoting efforts to quit and preventing relapse (10).
- The Maine Tobacco HelpLine increased the number of successful quit attempts by 300% (2).
- Oregon's state quit line has been successful in helping smokers quit. Six months after the initial consultation call, 13% have quit and 35% have made a serious attempt to quit (2).
Effectiveness Data
By contracting with health plans that incorporate a tobacco cessation program, both employers and employees benefit. After adding tobacco cessation services into its company health plans, Chevron reduced the number of employees who smoke by 43 percent over six years (11). Smoking rates among Union Pacific Railroad employees declined from 40% to 25% over a seven-year period following implementation of a comprehensive cessation program that included pharmacotherapy and counseling (5). Clearly, the addition of tobacco cessation assistance into their health plans allowed many employees to use the services and consequently achieve their goal to stop smoking.
Group Health Cooperative of Seattle offered full coverage of smoking cessation treatments through behavioral programs and nicotine-replacement therapy. Their employees were four times more likely than those without tobacco cessation treatment to attempt to quit and four times more likely to succeed with the service (5).
Resources
Campaign for Tobacco-Free Kids
(also known as National Center for Tobacco-Free Kids)
1400 Eye Street, Suite 1200
Washington, DC 20005
Phone: (202) 296-5469
http://www.tobaccofreekids.org
info@tobaccofreekids.org
Centers for Disease Control and Prevention,
Office on Smoking and Health
1600 Clifton Rd.
Atlanta, GA 30333
(404) 639-3311
http://www.cdc.gov
Center for Tobacco Cessation
901 E Street NW, Suite 500
Washington, DC 20004
(202) 585-3200
http://ctcinfo.org
National Cancer Institute
6116 Executive Boulevard
Room 3036A
Bethesda, MD 20892-8322
1-800-422-6237
http://www.nci.nih.gov
References
1. Action on Smoking and Health. (n.d.). Smoking in the Workplace Costs Employers Money. Retrieved July 9, 2004, from http://ash.org/papers/h100.htm
2. Campaign for Tobacco Free Kids. (2003). Tobacco cessation works: An overview of best practices and state experiences. Retrieved August 26, 2004, from
http://tobaccofreekids.org/research/factsheets/index.php?CategoryID=25
3. Campaign for Tobacco Free Kids. (2001). What kind of tobacco cessation might Medicare, Medicaid, and Private Health Insurers cover. Retrieved July 6, 2004, from http://tobaccofreedids.org/research/factsheets/pdf/0160.pdf
4. Centers for Disease Control and Prevention. (2002). Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs - United States, 1995-1999. Morbidity and Mortality Weekly Report, 51(14).
5. Centers for Disease Control and Prevention. (2004, January). Coverage for Tobacco Use Cessation Treatments. Retrieved July 9, 2004, from http://www.cdc.gov/tobacco/educational_materials/cessation
6. Centers for Disease Control and Prevention. (2004, January). State Medicaid Coverage for Tobacco-Dependence Treatments - United States, 1994-2002. Morbidity and Mortality Weekly Report, 53(03); 54-57.
7. Fiore, M. et al. (2000). Clinical practice guideline: Treating tobacco use and dependence. U.S. Surgeon General, pp. 42
8. Moody, R. J. (2003). Employees not helped to kick habit. The Business Journal of Portland, 1-2. Retrieved July 9, 2004, from http://portland.bizjournals.com/portland/stories/2003/07/14/story2.html
9. Pacific Center on Health and Tobacco. (n.d.). Health insurance benefits for treatment of tobacco dependence. Retrieved July 9, 2004, from http://www.paccenter.org/pages/pub_reports.htm
10. Robert Wood Johnson Foundation. (2003). Ten policy changes that could curb tobacco addiction: Recommendations from the Department of Health and Human Services. Retrieved August 26, 2004, from http://www.rwjf.org/news/special/curbTobacco_1.jhtml
11. Tobacco Free Oregon. (2003). Make it your business: Insure a tobacco-free workforce. Retrieved July 6, 2004, from http://www.tobaccofreeoregon.org/projects/miyb/pdf/toolkit_phase_one.pdf
Acknowledgements
Kirsten Hansen, Interim Executive Director, California Tobacco Control Alliance
Bill Furmanski, Interim Director, Center for Tobacco Cessation Policy
Dearell Niemeyer, MPH, Executive Director, Tobacco Technical Assistance Consortium, Atlanta, GA
Primary Author:
Teresa Pham, Center for Health Improvement, Sacramento, CA
Updated 9/21/04
