Medicaid coverage of cessation plus NRT – 8/3/06

Q:
a) Are you currently working with Medicaid to cover NRT? If yes, how do you/Medicaid address dual eligibility?
b) How does Medicaid interact with CMS to cover NRT?
c) Do you have data you can share?
d) Does your state tobacco program provide free or reduced rate NRT to Medicaid recipients?
e) Did you contract with GSK for NRT (or did Medicaid or the Quit Line)?

A:

1. Alabama - Alabama hasn't worked with Medicaid yet, but it is on our to do list this grant year.
    
2. Arizona –
   a) No
   b) N/A
   c) They do not because we do not offer/cover NRT.
   d) We do have data from our quitline that tells us what kind of insurance, if any, a client has that uses our program services.
   e) Arizona offers subsidized NRT (50%) to any client wanting to quit using tobacco provided they attend a local cessation class or participate in phone-based counseling through our quitline.
   f) No.
    
3. Massachusetts - MTCP is working with MassHealth (Medicaid) to design and now implement a new smoking cessation benefit. It covers counseling and all medications, including OTC patch, gum and lozenge.
   I assume Medicare will be billed for Medicare patients; I not sure about dually eligible. This would have to be address with our Medicaid agency.
   We have had various contracts with GSK for NRT which we distributed through our quitline. We purchase through UMass Medical School which now requires a competitive bid. Another vendor was lowest bidder for last NRT patch/gum purchase.
    
4. Michigan –
   a) Medicaid in Michigan covers the patch, so they are not eligible for the tobacco program's free NRT. (Assuming that is what is meant by dual eligible in this question.)
   b) I don't know.
   c) We have Medicaid NRT useage rates. Contact Karen Brown at brownks@michigan.gov for more information.
   d) No, since our Medicaid program has coverage for NRT.
   e) No, we got a better price through our state contract with AmeriSource Bergan.
    
5. North Carolina –
   a) Yes, as of July 2005 NC Medicaid covers all cessation pharmacotherapy meds, including prescription and OTC drugs.
   b) For people who are eligible for both Medicaid and Medicare in NC they cease to have coverage of drugs under Medicaid except for "excluded" drugs, for which they are still covered under Medicaid. In NC, OTC NRT is under the "excluded" drug category so dual eligibles can still get Medicaid coverage of OTC NRT, but not prescription cessation meds.
   c) NC Medicaid covers drugs for which they can get a rebate from the manufacturer and for which CMS will share the cost. For all of the cessation pharmacotherapy NC Medicaid is able to get both of these things so they are all covered. Once that agreement is made with CMS no further specific interaction is necessary to prescribe or distribute the meds.
   d) NC Medicaid is currently putting together a report of how many Medicaid enrollees in NC have filled prescriptions (both OTC and Rx) for cessation meds. I'm happy to share those data once I get them.
   e) As above - NC Medicaid covers all cessation pharmacotherapy for Medicaid enrollees.
   f) We currently do not offer NRT through our quitline and do not have a contract with any pharmaceutical company to provide NRT, although we are working on this.
    
6. Oklahoma –
   a) Oklahoma has enjoyed a long-standing relationship with its Medicaid agency. Fall 2003 brought Abby Rosenthal of the Centers for Disease Control and Prevention to Oklahoma to conduct three days of consultation, technical assistance and training to Oklahoma Public Health Professionals. Approximately 40 participants on the Cessation Team participated in an intensive day to develop a strategic plan for coordinated systemic cessation efforts statewide. An immediate result of the meeting was an agreement by the medical director of the Oklahoma Health Care Authority (OHCA) to provide immediate coverage cessation products for pregnant women. January 2004, OHCA Medical Advisory Committee approved the funding of both prescription and over-the-counter tobacco dependence treatment medications, for the entire Medicaid population. The Helpline serves as a resource to Medicaid tobacco users during their quit attempts, and the OSDH provides information to the OHCA on Medicaid enrollment in the Helpline’s intensive (5-call) counseling program.
   b) Over the counter Nicotine Replacement products continue to be covered by Oklahoma Medicaid for dual eligible individuals. These drugs will be covered ONLY if the client’s Medicare Part D Prescription Drug Plan does NOT pay for the drug.
   c) A claim must be submitted to the Medicare Part D PDP BEFORE a claim is submitted to Medicaid for NRT. These drugs are subject to the same restrictions, limitations, and requirements for dual eligible individuals as they are for any Medicaid covered individual.
   d) For data on the Oklahoma Tobacco Helpline contact: Tracey Strader, Executive Director, Oklahoma Tobacco Settlement Endowment Trust, 405-525-8738, traceys@tset.ok.gov.
   e) The Oklahoma Tobacco Helpline provides free NRT to uninsured adults age 18 years and older only. Medicaid clients are eligible to receive all smoking cessation products, including OTC products from the state Medicaid agency. All smoking cessation products are covered without prior authorization for the first 90 days, that is, claims are processed without a prior authorization. After 90 days of use in a 365-day period, further use of smoking cessation products requires prior authorization. Criterion for approval of prior authorization after the first 90 days of use: documentation that the patient is enrolled in a smoking cessation behavior modification program. Length of approval: Prior authorization can be approved for additional 90 days. After the patient has had 180 days of treatment in a 365-day period, the patient must wait 180 days before smoking cessation treatment will be covered again. Smoking cessation products do not count against the monthly prescription limit for Medicaid clients.
   f) Neither the Oklahoma Health Care Authority nor Oklahoma Tobacco Helpline contracts with GlaxoSmithKline for Nicotine Replacement Therapy.
    
7. Oregon –
   a) In Oregon, all plans accepting Medicaid clients are required to offer cessation services including behavioral counseling and pharmacotherapy.
   b) There are no dual eligibility problems because providing NRT to Medicaid clients is the responsibility of the plans, not the Tobacco Prevention and Education Program.
   c) Oregon has received a waiver from CMS to prioritize services - and providing cessation resources is at the top of the prioritized list.
   d) Please contact us (Cathryn.S.Cushing@state.or.us) and let us know what sort of data you are looking for. If we have it, we are happy to share it.
   e) Since we do not have the responsibility to provide NRT to Medicaid clients, we have resources available to offer a 4 week course of NRT to uninsured Oregonians and a 2 week starter kit to any eligible caller.
   f) We purchase NRT through our Quit Line vendor. I do not know if they have contracted with GSK
    
8. South Dakota - In South Dakota, Medicaid doesn't pay for "NRT", but they do pay for Zyban (Medicaid client pays $2 copay). The SD QL will pay half the cost of NRT (patches) OR Zyban (and all of the cost for QL coaching), so a Medicaid client can obtain Zyban via Medicaid and half price patches via enrolling in the QL.
   A few years ago we tried to work with GSK, but it basically amounted to our program "buying" vouchers from them and providing them to QL callers; we did not continue the program that way. Now we simply use a pharmacy benefits manager system (used by about 99% of pharmacies statewide), which is much easier to provide the patches and track participant use.
    
9. Utah -
   a) Yes - NRT is currently available to Medicaid eligible pregnant women through a contract with the Tobacco Prevention and Control Program (TPCP). The TPCP pays for the state match (27.96%) for NRT for pregnant women and draws down the federal match (72.04%).
   b) A Medicaid eligible pregnant woman can receive NRT by talking with her healthcare provider and receiving a prescription. She could also receive NRT (gum or patch) through the Utah Tobacco Quit Line, however, a physician's approval is required
   before NRT is mailed to a pregnant woman. With the pregnant woman's physician being involved in either instance, the woman, theoretically, should not get NRT from both sources.
   c) NRT is a part of Utah's covered pharmacy services for Medicaid eligible clients
   d) In FY06, 614 Medicaid eligible pregnant women received services, 44% reduced tobacco use and 34% quit tobacco use.
   e) Medicaid eligible clients are not required to pay for NRT.
   f) No
   
    

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