Does Insurance Coverage For Drug Therapy Affect Smoking Cessation?

Boyle, Raymond G.; Solberg, Leif I.; Magnan, Sally Sieloff; Davidson, Gestur; Alesci, Nina L.

doi:10.1377/hlthaff.21.6.162

Cited by 57 publications

(74 citation statements)

References 8 publications

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“…Increasingly, health insurance companies are providing coverage for NRT (40). However, most insurance companies require smokers who get NRT to obtain a prescription and/or attend a stop-smoking class (11,40). Many insurance companies also limit the number of courses of NRT a person can obtain in a given time period, which may deter smokers from making another quit attempt.…”

Section: Most Quit Attempts Are Made Without Nrtmentioning

confidence: 99%

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Impact of Nicotine Replacement Therapy on Smoking Behavior

Cummings

Hyland²

2005

Annu. Rev. Public Health

119

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This review summarizes evidence pertaining to the role of nicotine medications in smoking cessation and focuses particularly on evaluating evidence of the impact that nicotine replacement therapies (NRT) have had on altering population trends in smoking behavior. Accumulated evidence from controlled clinical trials has demonstrated that available forms of NRT (e.g., gum, transdermal patch, nasal spray, inhaler, and lozenge) increase quit rates compared with placebos by 50%-100%. However, despite the positive results from these studies, fewer than one in five smokers making a quit attempt do so with the benefit of NRT. Because not enough smokers are using NRT, the availability of NRT has not had a measurable impact on influencing population trends in smoking behavior. Among the factors contributing to the low utilization of nicotine medications are the inadequacies of the current dosage strengths and formulations of existing medications, smokers' perceptions of the high cost of the drugs, and concerns that many smokers have about safety and efficacy of nicotine medications. INTRODUCTIONConsiderable evidence supports the view that cigarette smoking is primarily maintained by an addiction to nicotine (51,91). Nicotine creates dependence by activating the mesolimbic dopaminergic reward system, and physiologic withdrawal symptoms occur when nicotine is no longer administered (59,67,71). Nicotine is an agonist of neural nicotinic acetylcholine receptors (NAChRs), which are found presynaptically in the central nervous system and postsynaptically in the autonomic nervous system (73). These receptors modulate the release of neurotransmitters. As a person's exposure to nicotine increases, NAChRs also are increased, which results in nicotine tolerance (60). Thus, factors that decrease the bioavailability of nicotine are hypothesized to increase an individual's cravings and decrease the likelihood of cessation because more of the drug is needed to achieve a given level of dopamine (13). Extrapolating from this evidence has led to the development of smoking cessation treatment methods that emphasize nicotine replacement (31). 584CUMMINGS HYLANDThe present review provides a brief summary of evidence pertaining to the role of nicotine medications, alone or in combination with other therapies in smoking cessation, and a critical analysis of the impact that these medications have had on altering population trends in smoking behavior. The discussion considers the role of nicotine replacement therapy (NRT) in a comprehensive population-based program developed to reduce the harms caused by tobacco. NICOTINE MEDICATION FOR SMOKING CESSATIONIn the mid-1980s, the vast majority (>90%) of former smokers reported that they stopped smoking without using medications or receiving formal assistance or help from anyone (33). However, this statistic has changed dramatically in the past two decades with the introduction and wide-scale availability of nicotine medications (46). Two-milligram prescription-only nicotine gum was first int...

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Section: Most Quit Attempts Are Made Without Nrtmentioning

confidence: 99%

“…However, OTC availability of nicotine patches and gum may only partially explain why NRT usage increased in younger smokers and those with lower incomes. During this same period health insurance coverage has favored nicotine medications, including state-financed public insurance programs for the poor (e.g., Medicaid) (11,40).…”

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confidence: 99%

Impact of Nicotine Replacement Therapy on Smoking Behavior

Cummings

Hyland²

2005

Annu. Rev. Public Health

119

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“…5 Providing smoking cessation benefits alone is not likely to change the use of bupropion, patches or gum, or increase the rates of quitting unless accompanied by increased efforts to make smokers aware of insurance benefits and adding other types of cessation support. [127][128][129][130][131] …”

Section: Medicaid Recipientsmentioning

confidence: 99%

Tobacco Cessation in Primary Care: Maximizing Intervention Strategies

Anczak¹,

Nogler²

2003

Clinical Medicine & Research

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The most effective preventive intervention that a clinician can provide for tobacco-using patients against heart disease, cancer, cerebrovascular disease and chronic obstructive pulmonary disease is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete smoking cessation. Reduction provides no direct health benefits to the individual smoker. Interventions are readily available, but underutilized, in part due to lack of clinician training and organizational support.The present article summarizes the current guidelines for smoking cessation interventions as a framework from which to start. The guidelines incorporate the Transtheoretical Model of patient behavioral change and the "Five A's": Ask, Advise, Assess, Assist and Arrange. Pharmacotherapeutic tools, including nicotine replacement therapies (nicotine gums, patches, nasal sprays, inhalers and new therapies) and non-nicotine therapies (bupropion, clonidine, nortriptyline and other antidepressants and anxiolytics) are considered. Adherence validation methods, new approaches to tobacco and addiction treatment that appear in the recent research literature are reviewed.Beyond this framework, specific categories of tobacco users (including smokeless tobacco users), cultural and ethnic minorities, adolescents using snuff and bidis, women, Medicaid recipients, and users of multiple forms of tobacco require special consideration.With this framework and the modifications that may be required for specific categories of patients, practicing clinicians can incorporate into daily practice a successful tobacco cessation intervention program with quit rates approaching 20%.

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“…In comparison, 25 percent of firms offer a smoking-cessation program, a wellness program that clinical trials have found to be effective. 12 The largest firms, with 5,000 or more workers, were significantly more likely than smaller firms to offer most of these programs. For example, 53 percent of the largest firms offered weight-loss programs such as Weight Watchers versus 16 percent of small firms, and 57 percent of the largest firms offered health coaching versus 24 percent of small firms (not shown).…”

Section: Study Findingsmentioning

confidence: 98%