Why wouldn't insurers cover smoking cessation?


We recently reported that health insurers still aren't providing smoking cessation programs, despite the reform law requiring them to cover such preventive programs. The ones that do offer smoking cessation coverage have complicated and confusing policies, discouraging members from taking advantage of them.

This is a real problem. It is well established that smoking is the leading cause of preventable death in this country, causing more than 400,000 Americans every year to die from lung cancer, throat cancer and heart disease, to name a few of the obvious diseases.

These health issues cost the entire healthcare system, and especially payers, a substantial amount of money---$193 billion annually in direct medical costs and productivity losses, according to a report from the Georgetown University Health Policy Institute.

Smoking cessation programs covered by insurers already have proven successful. For example, the Massachusetts Medicaid program recouped $3 for every $1 spent on a smoking cessation program for its members in just the first 16 months of the program.

What's more, almost 70 percent of all smokers want to quit the addiction, but only 3 percent to 5 percent can do so without some sort of help. Yet when Georgetown researchers studied 39 health plans, they found that none of them took all of these vitally important steps: clearly stated that tobacco cessation treatment is covered; provided coverage for individual, group and phone counseling and tobacco cessation medication; provided treatments with no cost-sharing for members; and provided access to treatment without members having to meet prerequisites.

"I went in thinking this is one of those areas we'd see significant compliance because none of the clinical evidence is in dispute," said Mila Kofman, lead author of the Georgetown study.

If Kofman, who is a former insurance commissioner from Maine, was surprised that insurers' coverage of smoking cessation is spotty, then how can members be expected to navigate their policies to determine eligibility? And those policies are peppered with inconsistent and confusing statements, to boot?

Case in point: The report found that although 36 of the 39 health insurance policies reviewed said they cover tobacco cessation, 26 of the policies also stated various exclusions exempting tobacco cessation from coverage either entirely or partially.

To rectify this problem, Kofman and her fellow researchers recommended insurers "reexamine their products" to modify any exclusionary language. Otherwise, "huge variation in benefits will continue to be a problem, and tobacco users' access to tobacco treatment will continue to be limited," the report said.

Insurers have the opportunity to be part of the solution to a massive healthcare crisis. Preventing death and increasing the quality of peoples' lives, while not specifically the mission of health insurance companies, certainly could be viewed as a positive consequence of their business. By preventing the myriad of diseases caused by smoking, insurers could even reap significant financial rewards.

So why wouldn't insurers want to include smoking cessation programs within their health plans? I have no explanation. - Dina (@HealthPayer)