Partnering with Medicaid offices to address barriers to NRT access – 11/19/10

Q: New Hampshire is struggling with forming a partnership with the Office of Medicaid, specifically, making the case that there are evidence-based tobacco treatment protocols and that the state quitline is one. Although the Medicaid program reports that all nicotine replacement therapy (NRT) is covered, there are restrictions and barriers within the Medicaid policies that limit smokers' access to NRT (for example, the Medicaid Reimbursement List of participating pharmacies changes randomly).
 
Do other states have a "winning strategy" for partnering with their state Medicaid office? Please share any suggestions for developing a partnership with Medicaid and addressing barriers to accessing NRT.

A:

1. California: In California, our strategy included providing Medicaid with current data indicating the higher smoking prevalence amongst Medicaid beneficiaries compared to the general public and the cost savings their agency would stand to gain if their beneficiaries quit.
    
   Consider asking local pharmacies to update you with any formulary changes that may impact Medicaid beneficiaries and try to update your members as best as you can. Quitlines are an evidenced-based tobacco treatment and increase a smoker’s chance for success. Refer to the 2008 Clinical Practice Guideline on Treating Tobacco Use and Dependence.
    
   It may also be useful to provide them with the American Lung Association’s report, Helping Smokers Quit: State Cessation Coverage, highlighting smoking cessation coverage from state to state.
    
   Finally, I would refer to your sister state of Massachusetts and present their successful model of eliminating barriers and providing access to their beneficiaries resulting in a decrease in smoking prevalence, improved health outcomes, and state cost reduction.
    
   • Press release: Patrick Administration Announces Positive Results from MassHealth Smoking Cessation Benefit
      
   • Publication: Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence
      
2. Iowa: The Iowa Medicaid program began discussing the possibility of covering cessation medications back in 2006. We at the Iowa Department of Public Health met with them at that time simply to make them aware of our state’s quitline in the hopes we could have it mentioned/promoted to Medicaid members as they would access the medication benefit. Our Medicaid program liked the quitline so much they decided to require that Medicaid members be fax referred by their doctor and enroll in telephone counseling before they could access their medication benefit. Attached are the informational letters that were sent to Medicaid providers which explain the benefit in Iowa:
    
   • Changes to the Preferred Drug List (PDL) and the addition of coverage of smoking cessation drugs - 1/1/2007
      
   • Smoking Cessation Program for IowaCare Recipients – 2/1/2008
      
   • Iowa Medicaid Smoking Cessation Program Expansion – 2/18/2008
      
   The fax referral forms required by Iowa Medicaid can be found here and here. Medicaid members comprise about a third of the people that use Quitline Iowa.
    
3. Oregon: Oregon's experience working with Medicaid is detailed in last year's Partnership Project Report, available here. Click here for the Oregon Medicaid Case Study.
    
4. West Virginia: In West Virginia, Medicaid has offered cessation services for many years by “piggybacking” first on the Public Employees Insurance Agency Quitline and now on the Division of Tobacco Prevention’s Quitline. Medicaid has their own agreement with beBetter Networks (quitline provider). beBetter provides eligibility verification for Medicaid members, and also recommends NRT, which the member receives from Medicaid’s pharmacy. beBetter also provides coaching.
    
   Make friends, offer any assistance they need, and wait. Do not push or insist. They eventually come around.

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Partner Response:

1. CDC Office on Smoking and Health: The Medicaid Partnership Project report has six case studies on states that have worked with their Medicaid folks.
    
   They might want to look at the Massachusetts article in PLoS, the Oct. 22, 2010 MMWR on State Medicaid Coverage for Tobacco-Dependence Treatments, and the Helping Smokers Quit: State Cessation Coverage 2010 report from the American Lung Association.

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