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Prescription Smoking-Cessation Medication Fills and Spending, 2009–2019

      Introduction

      Smoking is the leading cause of preventable disease and death. However, effective medicines, including prescription medications often covered by health insurance, are available to aid cessation.

      Methods

      Trends of 7 U.S. Food and Drug Administration–approved prescription medications for smoking cessation during 2009–2019 (before and during Affordable Care Act implementation), including fill counts and spending (total and patient, adjusted to 2019 U.S. dollars), were assessed among U.S. adults aged ≥18 years. Symphony Health's Integrated Dataverse combines data on >90% of outpatient prescription fills with market purchasing data to create national estimates. Analyses were conducted in 2021.

      Results

      Annually, total fills (spending) decreased from 3.7 million ($577 million) in 2009 to 2.5 million ($465 million) in 2013 and increased to 4.5 million ($1.279 billion) in 2019; patient spending decreased from $174 million (30% of total annual spending) in 2009 to $54 million (4%) in 2019. Comparing 2009 with 2019, the total spending per fill increased by 80% (from $157 to $282), whereas patient spending per fill decreased by 75% (from $47 to $12). The total spending per fill for branded products increased by 175% (from $166 to $459) and decreased by 41% (from $75 to $44) for generic products. Branded product percentage decreased from 89% to 57%.

      Conclusions

      Total fills and spending decreased from 2009 to 2013 and then increased through 2019, whereas patient spending decreased. Earlier studies suggest possible reasons for these trends, such as gradual implementation of federal requirements for insurance coverage of cessation medications and reduced cost sharing and financial barriers.
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      REFERENCES

      1. Centers for Disease Control and Prevention. How tobacco smoke causes disease: what it means to you. Atlanta, GA: Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet/pdfs/consumer.pdf. Published 2010. Accessed March 25, 2021.

        • National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health
        The health consequences of smoking: 50 years of progress. a report of the Surgeon General.
        HHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
        https://www.ncbi.nlm.nih.gov/books/NBK179276/
        Date accessed: February 1, 2022
        (Accessed February 1, 2022)
        • Critchley JA
        • Capewell S.
        Smoking cessation for the secondary prevention of coronary heart disease.
        Cochrane Database Syst Rev. 2003; Cd003041https://doi.org/10.1002/14651858.CD003041
        • Gerber Y
        • Rosen LJ
        • Goldbourt U
        • Benyamini Y
        • Drory Y
        Israel Study Group on First Acute Myocardial Infarction. Smoking status and long-term survival after first acute myocardial infarction a population-based cohort study.
        J Am Coll Cardiol. 2009; 54: 2382-2387https://doi.org/10.1016/j.jacc.2009.09.020
        • Prochaska JJ
        • Benowitz NL.
        Smoking cessation and the cardiovascular patient.
        Curr Opin Cardiol. 2015; 30: 506-511https://doi.org/10.1097/HCO.0000000000000204
        • Patel MS
        • Steinberg MB.
        In the clinic. Smoking cessation.
        Ann Intern Med. 2016; 164: ITC33-ITC48https://doi.org/10.7326/AITC201603010
      2. HHS. Smoking cessation: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf. Published 2020. Accessed May 1, 2021.

        • Cornelius ME
        • Wang TW
        • Jamal A
        • Loretan CG
        • Neff LJ.
        Tobacco product use among adults - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1736-1742https://doi.org/10.15585/mmwr.mm6946a4
        • Tibuakuu M
        • Okunrintemi V
        • Jirru E
        • et al.
        National trends in cessation counseling, prescription medication use, and associated costs among U.S. adult cigarette smokers.
        JAMA Netw Open. 2019; 2e194585https://doi.org/10.1001/jamanetworkopen.2019.4585
        • Tobacco Use and Dependence Guideline Panel
        Treating tobacco use and dependence: 2008 update.
        HHS, Rockville, MD2008
        https://www.ncbi.nlm.nih.gov/books/NBK63952/
        Date accessed: February 1, 2022
        • van den Brand FA
        • Nagelhout GE
        • Reda AA
        • et al.
        Healthcare financing systems for increasing the use of tobacco dependence treatment.
        Cochrane Database Syst Rev. 2017; CD004305https://doi.org/10.1002/14651858.CD004305.pub5
        • Brantley EJ
        • Greene J
        • Bruen BK
        • Steinmetz EP
        • Ku LC.
        Policies affecting Medicaid beneficiaries’ smoking cessation behaviors.
        Nicotine Tob Res. 2019; 21: 197-204https://doi.org/10.1093/ntr/nty040
        • Jarlenski M
        • Hyon Baik S
        • Zhang Y
        Trends in use of medications for smoking cessation in Medicare, 2007-2012.
        Am J Prev Med. 2016; 51: 301-308https://doi.org/10.1016/j.amepre.2016.02.018
        • McAfee T
        • Babb S
        • McNabb S
        • Fiore MC.
        Helping smokers quit–opportunities created by the Affordable Care Act.
        N Engl J Med. 2015; 372: 5-7https://doi.org/10.1056/NEJMp1411437
      3. The Patient Protection and Affordable Care Act; 42 U.S.C. § 2502 (2010). https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf. Accessed February 1, 2022.

        • Ku L
        • Bruen BK
        • Steinmetz E
        • Bysshe T.
        Medicaid tobacco cessation: big gaps remain in efforts to get smokers to quit.
        Health Aff (Millwood). 2016; 35: 62-70https://doi.org/10.1377/hlthaff.2015.0756
        • Ritchey M
        • Tsipas S
        • Loustalot F
        • Wozniak G.
        Use of pharmacy sales data to assess changes in prescription- and payment-related factors that promote adherence to medications commonly used to treat hypertension, 2009 and 2014.
        PLoS One. 2016; 11e0159366https://doi.org/10.1371/journal.pone.0159366
        • Yang PK
        • Ritchey MD
        • Tsipas S
        • Loustalot F
        • Wozniak GD.
        State and regional variation in prescription- and payment-related promoters of adherence to blood pressure medication.
        Prev Chronic Dis. 2020; 17: E112https://doi.org/10.5888/pcd17.190440
      4. Consumer price index historical tables for U.S. city average. U.S. Bureau of Labor Statistics. https://www.bls.gov/regions/mid-atlantic/data/consumerpriceindexhistorical_us_table.htm. Published 2021. Accessed May 1, 2021.

        • DiGiulio A
        • Haddix M
        • Jump Z
        • et al.
        State Medicaid expansion tobacco cessation coverage and number of adult smokers enrolled in expansion coverage - United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1364-1369https://doi.org/10.15585/mmwr.mm6548a2
        • Ku L
        • Brantley E
        • Bysshe T
        • Steinmetz E
        • Bruen BK.
        How Medicaid and other public policies affect use of tobacco cessation therapy, United States, 2010–2014.
        Prev Chronic Dis. 2016; 13: E150https://doi.org/10.5888/pcd13.160234
        • Koma JW
        • Donohue JM
        • Barry CL
        • Huskamp HA
        • Jarlenski M.
        Medicaid coverage expansions and cigarette smoking cessation among low-income adults.
        Med Care. 2017; 55: 1023-1029https://doi.org/10.1097/MLR.0000000000000821
        • Adams AJ
        • Hudmon KS.
        Pharmacist prescriptive authority for smoking cessation medications in the United States.
        J Am Pharm Assoc (2003). 2018; 58: 253-257https://doi.org/10.1016/j.japh.2017.12.015
        • Richard P
        • West K
        • Ku L
        The return on investment of a Medicaid tobacco cessation program in Massachusetts.
        PLoS One. 2012; 7: e29665https://doi.org/10.1371/journal.pone.0029665
        • Baker CL
        • Ding Y
        • Ferrufino CP
        • Kowal S
        • Tan J
        • Subedi P.
        A cost–benefit analysis of smoking cessation prescription coverage from a U.S. payer perspective.
        Clinicoecon Outcomes Res. 2018; 10: 359-370https://doi.org/10.2147/CEOR.S165576
        • McCallum DM
        • Fosson GH
        • Pisu M.
        Making the case for Medicaid funding of smoking cessation treatment programs: an application to state-level health care savings.
        J Health Care Poor Underserved. 2014; 25: 1922-1940https://doi.org/10.1353/hpu.2014.0171
        • Javitz HS
        • Swan GE
        • Zbikowski SM
        • et al.
        Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer's perspective.
        Value Health. 2004; 7: 535-543https://doi.org/10.1111/j.1524-4733.2004.75005.x
      5. Tobacco cessation change package. Millions Heart, U.S. Centers for Disease Control and Prevention. https://millionhearts.hhs.gov/tools-protocols/action-guides/tobacco-change-package/index.html. Published 2020. Accessed November 25, 2020.

        • Babb S
        • Malarcher A
        • Schauer G
        • Asman K
        • Jamal A.
        Quitting smoking among adults - United States, 2000–2015.
        MMWR Morb Mortal Wkly Rep. 2017; 65: 1457-1464https://doi.org/10.15585/mmwr.mm6552a1
        • Richter KP
        • Shergina E
        • Grodie A
        • et al.
        Direct observation of Medicaid beneficiary attempts to fill prescriptions for nicotine replacement medications.
        J Am Pharm Assoc (2003). 2018; 58: 432-437https://doi.org/10.1016/j.japh.2018.03.006
        • Holla N
        • Brantley E
        • Ku L.
        Physicians’ recommendations to Medicaid patients about tobacco cessation.
        Am J Prev Med. 2018; 55: 762-769https://doi.org/10.1016/j.amepre.2018.07.013