Coverage for Tobacco Cessation Programs

On May 4, 2017, the Vermont Department of Financial Regulation published Insurance Bulletin 193, which relates to tobacco cessation programs. The purpose of the bulletin is to remind insurers of the importance of offering tobacco cessation programs and communicating the availability of the programs. According to the bulletin, both the ACA and Vermont law require coverage for such programs without cost-sharing. The bulletin describes that insurers must provide coverage for at least two tobacco cessation attempts per year, and that covering a “cessation attempt” includes two potential methods. The first includes all FDA-approved tobacco cessation medications (including both prescription and over-the-counter medications for a 90-day treatment regimen when proscribed by a health care provider). The second includes four tobacco cessation counseling sessions of at least 10 minutes each (including telephone, group and individual counseling). The bulletin also notes that HHS has issued guidance describing tobacco cessation products to include nicotine gum, patches, lozenges, oral or nasal spray, or inhalers, and two tobacco-cessation drugs (Bupropion and Varenicline).

The bulletin contains no new employer obligations, but is a helpful resource for employers with fully insured plans and questions relating to tobacco cessation as a covered health insurance benefit.

Insurance Bulletin 193 »