Medicaid Coverage and Utilization of Covered Tobacco-Cessation Treatments: The Arkansas Experience

BackgroundAlthough most Medicaid programs have some coverage for tobacco-cessation treatments, little is known about how well the covered treatments are utilized among Medicaid enrollees.PurposeTo examine the impact of Arkansas Medicaid coverage of tobacco-cessation treatment on utilization of FDA-approved tobacco-cessation pharmacotherapies and counseling services by Medicaid enrollees.MethodsThis study used Arkansas Medicaid administrative claims data from October 1, 2003, to June 30, 2008. Trend changes in the following monthly measures were examined: (1) total number of pharmacy claims for each covered pharmacotherapy; (2) total number of medical claims for counseling services; and (3) total number of unique enrollees who received each type of covered tobacco-cessation treatment. Average unit of defined daily dose and days with treatment stratified by tobacco-cessation products within 180 days after the first tobacco-cessation treatment were examined for intensity of treatment. Data collection was finished in 2009 and analysis was completed in 2011.ResultsBy June 30, 2008, a total of 12,673 enrollees received some tobacco-cessation treatments, and 77% of them received pharmacotherapies only. Implementation of the coverage expansion generated an initial increase in utilization of tobacco-cessation medications but quickly declined after 3 months. Utilization increased again when varenicline was added, but also decreased sharply after 6 months. Patterns of monthly claims for counseling services appeared to be inconsistent with the policy change.ConclusionsMedicaid coverage alone may have limited sustained effect on increasing utilization of the covered tobacco-cessation treatments among Medicaid enrollees.