Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women)

2018

Location	Benefit Covered	Copayment Required?	Limits on Services
United States	Yes - 46 No - 0 NR - 5	Yes - 20	Yes - 25
Alabama	Yes	$0-3.90 dependent on drug cost	Requires PA
Alaska	Yes	No	No
Arizona	Yes	No	Over the counter tobacco cessation only available in place of prescription drugs that are clinically appropriate and equally safe and less costly
Arkansas	Yes	No	up to 31 day supply per Rx and we have quantity limits
California	Yes	No	No
Colorado	Yes	$3 per prescription or refill	Each drug may be subject to utilization controls per the Preferred Drug List or Appendix P criteria.
Connecticut	Yes	No	Smoking cessation products are covered for all members enrolled in HUSKY A, HUSKY C, and HUSKY D. Smoking cessation products are not covered for members enrolled in HUSKY B. Both federal legend and over the counter products are covered. OTCs require a prescription from an enrolled provider.
Delaware	Yes	No	No
District of Columbia	Yes	$1.00/Rx	No
Florida	Yes	No	Day and Amount Limits may apply
Georgia	Yes	$0.50 to $3.00	No
Hawaii	Yes	No	Two(2) attempts per year.
Idaho	Yes	No	No
Illinois	NR	NR	NR
Indiana	Yes	$3 per prescription	Pharmacotherapy and counseling services covered for pregnant women when rendered by appropriately qualified and enrolled providers up to 180 days of treatment (beyond that time requires prescriber to document medical necessity). Age limits also apply.
Iowa	NR	NR	NR
Kansas	Yes	$3.00 per prescription	Chantix or Zyban - 2 tablets per day; Patches - 1 per day; Inhaler - 16 cartridges per day; Nasal spray - 80 sprays per day; Lozenges - 20 per day; Gum - 24 pieces per day
Kentucky	Yes	Generic prescription drug $1 Preferred brand name drug $4	Tobacco Cessation Reimbursement. (1) The department shall reimburse for a tobacco cessation medication provided to a recipient if: (a) The medication is: 1. Medically necessary; 2. Approved by the FDA for tobacco cessation; 3. Prescribed for the recipient in accordance with Section 4 of this administrative regulation; and 4. If subject to prior authorization, prior authorized by the department; and (b) For a refill, the recipient has met the requirements established in Section 4(2) of this administrative regulation. (2) The department shall reimburse for no more than two (2) simultaneous tobacco cessation medications. (3) The department shall reimburse for a tobacco cessation medication in accordance with 907 KAR 1:018. (4) Reimbursement for a tobacco cessation medication shall be limited to two (2) courses of treatment per recipient per calendar year.
Louisiana	Yes	$0.50 -$3.00 based on ingredient cost with federally recognized exemptions. Additional copayment exemptions on USPSTF recommendations	30 or 90 day supply based on the agent prescribed and dispensed; there may be duration limits on smoking cessation products with some MCOs
Maine	Yes	No	No
Maryland	Yes	$1 for generic and preferred brand name drugs; $3 for other brand name drugs	NR
Massachusetts	Yes	No	No
Michigan	Yes	No	Coverages defined in policy and Michigan Pharmaceutical Product List (MPPL).
Minnesota	Yes	No	No
Mississippi	Yes	$3 per Rx	2 Brand/5 prescription limit per month
Missouri	Yes	$0.50-$2 based on ingredient cost	No
Montana	Yes	No	Limited to 8 months per year without a PA and quantity limits per label.
Nebraska	Yes	No	No
Nevada	NR	NR	NR
New Hampshire	Yes	zero, 1.00 and 2.00 dependent upon multiple factors: FPL, drug, if waiver recipient and preferred drug status	PDL class
New Jersey	Yes	No	quantity limits
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	$1 - $3 depending on the service	There is a quantity limit of a 6 month supply per 12 months for Chantix, Preferred drugs: Buproban® Tablet (branded generic for Zyban®), bupropion SR tablet (generic for Zyban®), Chantix® Tablet / Starting Box / Continuation Month Box, Nicorelief® Gum, Nicorette® Gum / Lozenge, nicotine gum / lozenge / patch. Trial and failure of two preferred drugs required before prescription for the following non-preferred drugs: Nicoderm® CQ Patch, Nicotrol® Inhaler / NS Spray, and Zyban® SR Tablet, Nicorette Gum/lozenge (buccal)
North Dakota	Yes	$3 per prescription fill for brand names only	Limited to one attempt per agent every two years.
Ohio	Yes	No	No
Oklahoma	Yes	No	No
Oregon	Yes	No	No
Pennsylvania	Yes	$1.00 (Generic) and $3.00 (Brand)	No
Rhode Island	Yes	No	No
South Carolina	NR	NR	NR
South Dakota	Yes	$1/generic Rx, $3.30/brand Rx	No
Tennessee	Yes	$3 for brand name drugs; $1.50 for generic drugs	Prescription required for TennCare to cover. Subject to the same limit as other prescription drugs described above.
Texas	Yes	No	No
Utah	Yes	$4 per prescription	24 weeks maximum per year for Chantix
Vermont	Yes	No	16 face-to-face tobacco cessation counseling visits per year; maximum may be exceeded based on medical necessity with prior authorization
Virginia	Yes	$1 for brand, $3 for brand in FFS	No
Washington	Yes	No	just to confirm they are also receiving counseling
West Virginia	Yes	No	Members are limited to 12 weeks of therapy per calendar year. Prior authorization for continuation of therapy beyond the initial 12-week approval requires a written appeal from the prescriber with documentation of efficacy and patient compliance. Compliance will be determined by claims review with no more than a five day lapse between pharmacy fills of current therapy
Wisconsin	Yes	No	The prescription must include a nicotine dependence diagnosis, otherwise prior approval is required
Wyoming	Yes	Yes, copay is $0.65 per prescription for generic drugs and $3.65 for brand name drugs	Utilization is managed through a Preferred Drug List, Dosage Limitation Chart and Additional Therapeutic Criteria Chart which can be found at www.wymedicaid.org

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Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women)

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Medicaid Benefits: Tobacco Cessation Products (Other Than As Required For Pregnant Women)

2018

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