Smoking Cessation Growth Opportunities Lay With Employers, Health Care Reform
This article was originally published in The Tan Sheet
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Many employers still hold a short-sighted view of the cost of smoking cessation therapies, panelists at an American University webinar said Nov. 16. "They are making a fundamental cost-benefit mistake if they think it is cheaper for them" to forgo funding for smoking cessation treatments in company-provided health care, said Matthew Mayers, president of the Campaign for Tobacco-Free Kids.
Key Points
Many companies fear they will pay for an employee's smoking cessation treatment only to have the employee go to another company shortly thereafter, negating the long-term savings, or they just cannot afford any additional health care costs in the current economy, said Stephen Melek, principal and consulting actuary at Milliman agency. "Short term, there's going to be an increased expense, long term there's going to be a tremendous savings," said Paul Handle, senior VP and chief medical officer of Health Care Services Corp. Bloomberg News recently released a report noting that for insurers, there is increased cost of providing smoking cessation for the first two years of the benefit, but after three years it becomes a savings, Mayers said. "Candidly, any wise company really can't afford to do otherwise," he said. Tipping Point Moderator James Thurber, director of the university's Center for Congressional and Political Studies, noted the Mental Health Parity and Addiction Equity Act and Patient Protection and Affordable Care Act both changed requirements for coverage of smoking cessation. The Mental Health Parity Act requires that if an insurance plan covers mental health and substance abuse treatments, they must be covered at a level comparable to surgical and medical treatment. "This legislation may be the tipping point to determine tobacco cessation coverage availability for the American public," Thurber said. However, "these laws still leave room for interpretation in critical areas," he said. PPACA, or health care reform, "prominently features smoking cessation as a key element" in its emphasis on preventive medicine, Thurber said. The government has yet to detail smoking cessation benefit regulations under PPACA, explained Mayers. "We're still hopeful the regulations will eventually, and relatively rapidly, be more detailed," he added. There has been no sign the Department of Health and Human Services thinks the regulations are ambiguous, he noted. "We all knew there would be a period of time where you had to define things more precisely," he said. One section of the legislation requires insurers to cover preventive services with no cost sharing, provided those services have been given an "A" or "B" rating by the U.S. Preventive Services Task Force, according to a July 2010 letter from advocacy groups to HHS Secretary Kathleen Sebelius. Mayers was a signatory to the letter.
The time interval between when the task force issues a preventive care recommendation and insurers must include coverage must be at least one year, according to the legislation. In April 2009, the Task Force gave an "A" recommendation to counseling and interventions to prevent tobacco use, "recognizing that the net benefit of these services is high," according to the groups, including the American Lung Association and the Campaign for Tobacco-Free Kids. The groups urge any definition of tobacco cessation benefits issued by HHS require health plans to cover all three types of counseling deemed effective (individual face-to-face, group and phone); require plans to cover all seven FDA-approved medications to treat tobacco addiction and promote tobacco cessation treatments to smokers. The FDA-approved treatments include OTC nicotine replacement gums, patches and lozenges. "Health plans and insurers should make these medications as easy as possible to obtain, so as not to present barriers that delay or obstruct the already difficult quitting process," the groups say. They urge Sebelius to ban restrictions on coverage for OTCs, requirements of physician pre-authorization or step therapy – requiring patients to attempt treatment with one medication before covering a different one. Pfizer, which markets prescription products Nicotrol NRT nasal spray and inhalation formulations and Chantix (varenicline) smoking cessation tablets, sponsored the panel, though Thurber noted the university chose the panelists. Support Grows For Expanded OTC Treatment A study by Pennsylvania State University found all types of prescription and OTC smoking cessation saved states money over not funding the treatment (Also see "Smoking Cessation Savings Outweigh Costs Of Subsidies - Study" - Pink Sheet, 20 Sep, 2010.). There has been a push to expand availability and access to smoking cessation therapies, particularly OTC nicotine replacement therapies. In February, the Association for Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco asked FDA to hold a workshop on expanding availability, including shortening warnings and allowing sale of smaller packages. GlaxoSmithKline, which manufactures NicoDerm CQ patches and Commit lozenges and has a license from McNeil Consumer Healthcare to market Nicorette gum in the U.S., applauded the petition (Also see "NRT Petition Calls On FDA To Greatly Expand Indications, Availability" - Pink Sheet, 1 Mar, 2010.). FDA held a scientific workshop in October to study the risk and benefits of changing labeling to allow NRT use beyond 12 weeks, which an official said was a probable predecessor to an advisory committee (Also see "Advisory Committee On NRT Indications Appears Likely Following Workshop" - Pink Sheet, 1 Nov, 2010.). |