As per the U.S. Food and Drug Administration (FDA), there are seven approved tobacco cessation medications available to people who want to quit smoking. But did you know that under the ACA, health insurance policies sold on health exchanges need to cover all seven smoking cessation drugs, without cost sharing, for everyone? However, not all states have ensured that this ACA requirement is being met. In fact, only a single state ensures that its health plans this requirement.
West Virginia, which has a single health plan offering plans on its marketplace, has covered all these seven medications under the health plan. On the other hand, states like Arkansas, Hawaii, Mississippi, South Dakota and Vermont, do not have a single plan that covers all seven of the smoking cessation medications. Let’s take a deeper dive into the available data.
There are 348 health insurance providers participating in the exchanges, but out of these, only 144 listed all the seven medications in their offered plans. Out of the 144, only 60 providers mentioned the no cost-sharing provision as required by the law. For the remaining providers, although no clear indication was available, but the absence of the clause could mean that the providers might have charged unsuspecting patients for the seven drugs. On the other hand, as many as 98.4 percent of these health plans cover two or more of these medicines.
Although 34 states have their exchanges operating through the federal marketplace, there is no substantial statistical difference for compliance with the smoking cessation requirements. On the other end of the spectrum, California, Minnesota, Louisiana, Wisconsin and Maryland are leading the charge in compliance with smoking cessation requirements, but they still far from complete compliance across all offerings. California is faring the best, with 6 of 10 health plans covering all seven smoking cessation medications without any cost sharing angle. Minnesota is next, with 3 of 5 compliant plans.
States definitely need to rethink their approach, especially those states that are burdened by high tobacco use. Smoking continues to be the leading preventable cause of death in the U.S., it is necessary that insurers offer all seven plans under their coverage options. It is a matter of providing all available options to people who are taking the steps to overcome the addiction.
In itself, the problem of noncompliance with smoking cessation requirements is a part of a larger ignorance toward several ACA mandates. For all the ACA customer protections in place, health insurers have circumvented some. For instance, use of drug formularies to exclude sicker patients or prevalence of increasingly narrow networks of hospitals and physicians that make it difficult for care seekers to get care. Through these measures, health insurers have taken advantage of more than one ACA mandate while in practice, the law is supposed to make sure that the insurers cannot take advantage of their customers.
What’s needed here is a follow up on all ACA mandates that have slipped under the radar. The administration needs to revisit aspects like smoking cessation and fine health plans that are dodging the mandates. A parallel approach would be to educate people continually on what they are entitled to through Obamacare.