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Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members Who Smoke

Published:November 02, 2022DOI:https://doi.org/10.1016/j.amepre.2022.09.008

      Introduction

      Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines’ provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them.

      Methods

      This secondary analysis examined the differences in the source and use of cessation treatment by insurance type and their impacts on cessation. The parent trial excluded people who were pregnant, had private insurance, or were not ready to quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income people who smoke daily completed a baseline survey and were enrolled in a quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were completed in August 2022. Participants were classified as Medicaid/dual (55%), Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the trial, owing to a system error, the quitline provided nicotine replacement therapy to all study participants regardless of insurance type.

      Results

      Before error versus after error, Medicaid participants reported lower nicotine replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds of quitting (7-day point prevalence) by 3 months increased for people who smoke who completed more quitline calls and used any (36% quit) versus used no (20% quit) pharmacotherapy, but quitting did not differ by insurance classifications (27%–29%). Getting and using nicotine replacement therapy from the quitline produced the highest quit rates (38%).

      Conclusions

      Results illustrate the benefit of receiving nicotine replacement therapy from the quitline on cessation. Mailing nicotine replacement therapy to all people who smoke should be standard practice to reduce smoking disparities.
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      REFERENCES

        • Cornelius ME
        • Loretan CG
        • Wang TW
        • Jamal A
        • Homa DM.
        Tobacco product use among adults - United States, 2020.
        MMWR Morb Mortal Wkly Rep. 2022; 71: 397-405https://doi.org/10.15585/mmwr.mm7111a1
        • Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff
        A clinical practice guideline for treating tobacco use and dependence: 2008 Update. A U.S. Public Health Service Report.
        Am J Prev Med. 2008; 35: 158-176https://doi.org/10.1016/j.amepre.2008.04.009
        • Stead LF
        • Perera R
        • Lancaster T.
        Telephone counseling for smoking cessation.
        Cochrane Database Syst Rev. 2006; 3CD002850https://doi.org/10.1002/14651858.CD002850.pub2
        • Zaza S
        • Briss PA
        • Harris KW.
        The Guide to Community Preventive Services: What Works to Promote Health?.
        Oxford University Press, Oxford, United Kingdom2005https://doi.org/10.1093/acprof:oso/9780195151091.001.0001
        • Eisenberg MJ
        • Filion KB
        • Yavin D
        • et al.
        Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials [published correction appears in CMAJ. 2008;179(8):802].
        CMAJ. 2008; 179: 135-144https://doi.org/10.1503/cmaj.070256
        • Dabas D.
        Therapies for smoking cessation: a meta-analysis of double-blind randomized controlled trials.
        J Health Sci Res. 2018; 9: 49-56https://doi.org/10.5005/jp-journals-10042-1069
        • McAfee TA.
        Quitlines a tool for research and dissemination of evidence-based cessation practices.
        Am J Prev Med. 2007; 33 (suppl): S357-S367https://doi.org/10.1016/j.amepre.2007.09.011
        • Smith SS
        • Keller PA
        • Kobinsky KH
        • et al.
        Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant.
        Nicotine Tob Res. 2013; 15: 718-728https://doi.org/10.1093/ntr/nts186
        • Bandi P
        • Cokkinides VE
        • Virgo KS
        • Ward EM.
        The receipt and utilization of effective clinical smoking cessation services in subgroups of the insured and uninsured populations in the USA.
        J Behav Health Serv Res. 2012; 39: 202-213https://doi.org/10.1007/s11414-011-9255-x
        • Zhang L
        • Babb S
        • Schauer G
        • Asman K
        • Xu X
        • Malarcher A.
        Cessation behaviors and treatment use among U.S. smokers by insurance status, 2000–2015.
        Am J Prev Med. 2019; 57: 478-486https://doi.org/10.1016/j.amepre.2019.06.010
        • Bailey SR
        • Heintzman J
        • Jacob RL
        • Puro J
        • Marino M.
        Disparities in smoking cessation assistance in U.S. primary care clinics.
        Am J Public Health. 2018; 108: 1082-1090https://doi.org/10.2105/AJPH.2018.304492
      1. National health interview survey: 2015 data release.
        Centers for Disease Control and Prevention. November 3, 2017; (UpdatedAccessed July 2018)
        • Kotz D
        • West R.
        Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding.
        Tob Control. 2009; 18: 43-46https://doi.org/10.1136/tc.2008.025981
        • Brady BR
        • O'Connor PA
        • Martz MP
        • Grogg T
        • Nair US
        Medicaid-insured client characteristics and quit outcomes at the Arizona smokers’ helpline.
        J Behav Health Serv Res. 2022; 49: 61-75https://doi.org/10.1007/s11414-021-09756-2
        • DiGiulio A
        • Jump Z
        • Babb S
        • et al.
        State Medicaid coverage for tobacco cessation treatments and barriers to accessing treatments - United States, 2008–2018.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 155-160https://doi.org/10.15585/mmwr.mm6906a2
        • North American Quitline Consortium
        Medicaid reimbursement for Quitline pharmacy products.
        North American Quitline Consortium, Phoenix, AZJanuary 2021 (PublishedAccessed July 2022)
        • McMenamin SB
        • Halpin HA
        • Ibrahim JK
        • Orleans CT.
        Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatments.
        Am J Prev Med. 2004; 26: 99-104https://doi.org/10.1016/j.amepre.2003.10.017
        • McMenamin SB
        • Halpin HA
        • Bellows NM.
        Knowledge of Medicaid coverage and effectiveness of smoking treatments.
        Am J Prev Med. 2006; 31: 369-374https://doi.org/10.1016/j.amepre.2006.07.015
        • Knox B
        • Mitchell S
        • Hernly E
        • Rose A
        • Sheridan H
        • Ellerbeck EF.
        Barriers to utilizing Medicaid smoking cessation benefits.
        Kans J Med. 2017; 10: 1-11https://doi.org/10.17161/kjm.v10i4.8669
        • Keller PA
        • Christiansen B
        • Kim SY
        • et al.
        Increasing consumer demand among Medicaid enrollees for tobacco dependence treatment: the Wisconsin “Medicaid covers it” campaign.
        Am J Health Promot. 2011; 25: 392-395https://doi.org/10.4278/ajhp.090923-QUAN-311
        • Williams RK
        • Brookes RL
        • Singer ER.
        A framework for effective promotion of a Medicaid tobacco cessation benefit.
        Health Promot Pract. 2020; 21: 624-632https://doi.org/10.1177/1524839919829452
        • Anderson CM
        • Cummins SE
        • Kohatsu ND
        • Gamst AC
        • Zhu SH.
        Incentives and patches for Medicaid smokers: an RCT.
        Am J Prev Med. 2018; 55 (suppl 2): S138-S147https://doi.org/10.1016/j.amepre.2018.07.015
        • Anderson CM
        • Kirby CA
        • Tong EK
        • Kohatsu ND
        • Zhu SH.
        Effects of offering nicotine patches, incentives, or both on quitline demand.
        Am J Prev Med. 2018; 55 (suppl 2): S170-S177https://doi.org/10.1016/j.amepre.2018.07.007
        • McQueen A
        • Roberts C
        • Garg R
        • et al.
        Specialized tobacco quitline and basic needs navigation interventions to increase cessation among low income smokers: study protocol for a randomized controlled trial.
        Contemp Clin Trials. 2019; 80: 40-47https://doi.org/10.1016/j.cct.2019.03.009
        • Heatherton TF
        • Kozlowski LT
        • Frecker RC
        • Rickert W
        • Robinson J.
        Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.
        Br J Addict. 1989; 84: 791-799https://doi.org/10.1111/j.1360-0443.1989.tb03059.x
        • Piper ME
        • Bullen C
        • Krishnan-Sarin S
        • et al.
        Defining and measuring abstinence in clinical trials of smoking cessation interventions: an updated review.
        Nicotine Tob Res. 2020; 22: 1098-1106https://doi.org/10.1093/ntr/ntz110
        • Garg R
        • McQueen A
        • Roberts C
        • et al.
        Stress, depression, sleep problems and unmet social needs: baseline characteristics of low-income smokers in a randomized cessation trial.
        Contemp Clin Trials Commun. 2021; 24100857https://doi.org/10.1016/j.conctc.2021.100857
        • Zhu SH
        • Anderson CM
        • Wong S
        • Kohatsu ND.
        The growing proportion of smokers in Medicaid and implications for public policy.
        Am J Prev Med. 2018; 55 (suppl 2): S130-S137https://doi.org/10.1016/j.amepre.2018.07.017
        • Kizer KW.
        Advancing tobacco control among Medicaid beneficiaries: a historical perspective and call to action [published correction appears in Am J Prev Med. 2019;56(4):629].
        Am J Prev Med. 2018; 55 (suppl 2): S222-S226https://doi.org/10.1016/j.amepre.2018.08.010
        • 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
        • Ali-Faisal SF
        • Colella TJ
        • Medina-Jaudes N
        Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: a meta-analysis of randomized controlled trials.
        Patient Educ Couns. 2017; 100: 436-448https://doi.org/10.1016/j.pec.2016.10.014
        • Corelli RL
        • Tu TG
        • Lee KJ
        • Dinh D
        • Gericke KR
        • Hudmon KS.
        Smoking cessation pharmacotherapy utilization and costs to a Medicaid managed care plan.
        Pharmacoecon Open. 2021; 5: 649-653https://doi.org/10.1007/s41669-021-00274-7
        • Hollands GJ
        • McDermott MS
        • Lindson-Hawley N
        • Vogt F
        • Farley A
        • Aveyard P.
        Interventions to increase adherence to medications for tobacco dependence.
        Cochrane Database Syst Rev. 2015; CD009164https://doi.org/10.1002/14651858.CD009164.pub2
        • Leone FT
        • Zhang Y
        • Evers-Casey S
        • et al.
        Initiating pharmacologic treatment in tobacco-dependent adults. An official American Thoracic Society Clinical Practice Guideline.
        Am J Respir Crit Care Med. 2020; 202: e5-e31https://doi.org/10.1164/rccm.202005-1982ST