Tobacco Cessation News :
Medicare Adds Coverage for Smoking Cessation

The Centers for Medicare and Medicaid (CMS) today announced it is adding coverage for smoking and tobacco use cessation counseling for certain beneficiaries that will help them quit the habit. This counseling benefit is effective as of March 2005; a benefit for prescription medications to quit smoking will go into effect January 1, 2006.

“Covering smoking and tobacco use cessation counseling for seniors has great potential to save and improve lives for millions of seniors,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “This is another step in turning Medicare into a prevention-oriented health program.”

The coverage decision, which was proposed for public comment in December, involves Medicare beneficiaries who have an illness caused or complicated by tobacco use, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots, and cataracts – the diseases that account for the bulk of Medicare spending today. It also applies to beneficiaries who take any of the many medications whose effectiveness is complicated by tobacco use – including insulins and medicines for high blood pressure, blood clots and depression.

Public comments generally supported the approach that CMS proposed, although some commenters preferred broader coverage of all tobacco users. CMS modified the proposal in response to comments by removing a requirement that providers have uniform training in smoking and tobacco use cessation counseling, since no nationally accepted standards exist. When standards do become available, CMS plans to consider whether to add those requirements to its coverage policy.

“Millions of Medicare beneficiaries have smoked for many years, and are now experiencing the heart problems, respiratory problems, and many other often-fatal diseases that smoking can cause,” McClellan said. “It’s really hard to quit, but we are going to do everything we can to help. I especially want to urge smokers on Medicare who are just starting to experience heart problems or lung problems or high blood pressure to take advantage of this new step.”

The Centers for Disease Control and Prevention (CDC) has estimated that 9.3 percent of Americans age 65 and older smoke cigarettes. About 440,000 people die annually from smoking related disease, with 300,000 of those deaths in those 65 and older. CDC estimated in 2002 that 57 percent of smokers age 65 and over report a desire to quit. Currently, about 10 percent of elderly smokers quit each year, with 1 percent relapsing.

“The evidence fully supports the hope that seniors with diseases and health effects caused by smoking and tobacco use can quit, given the right assistance,” McClellan said.

The CMS decision to cover cessation counseling comes in response to a June, 2004 request from the Partnership for Prevention (PFP). The PFP requested CMS open a National Coverage Decision (NCD) to consider coverage of tobacco cessation counseling as detailed in the U.S. Department of Health and Human Services, Public Health Service (PHS) 2000 Clinical Practice Guideline: Treating Tobacco Use and Dependence.

The PHS 2000 Guideline has been endorsed by many healthcare and professional organizations. Based on the evidence that is reflected in the guidelines, CMS had decided to extend smoking and tobacco use cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking related disease or are taking certain drugs whose metabolism is affected by tobacco use. This announcement builds on a series of HHS initiatives designed to help Americans quit smoking, including the opening of a new national quitline (1-800-QUITNOW) and designating all HHS campuses tobacco-free.

While many may think that those who quit at age 65 or older fail to reap the health benefits of abstinence from tobacco, the U.S. Surgeon General has reported that the benefits of cessation do extend to quitting at older ages. Smoking cessation in older adults leads to significant risk reduction and other health benefits, even in those who have smoked for years.

Medicare’s upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

“Federal policy has acknowledged tobacco as the number one cause of preventable death for decades now, and CMS has taken the lead in implementing coverage policy for our seniors to deal directly with this critical health problem,” said Sean Tunis, M.D., CMS’ Chief Medical Officer.

Researchers estimate that smoking accounts for approximately 10% of the total costs of the Medicare program or about $20.5 billion in 1997. On average, nonsmokers survived 1.6-3.9 years longer than those who have never smoked.

The final Medicare coverage decision is available on the CMS Website at https://www.cms.gov/coverage/.

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