Insurance coverage for smoking cessation not always effective

November 12, 2002

Just because a health plan will pay for smokers to try to quit doesn't mean they will, results of a new study suggest.

When two Minnesota health plans - Blue Cross Blue Shield and HealthPartners - decided in 1999 to cover the cost of anti-smoking drugs like bupropion and nicotine patches, researchers recruited more than 2,300 volunteers inside and outside those plans to see what would happen.

"Smokers with the benefit were no more likely to quit than were smokers without the benefit," reports lead author Raymond G. Boyle, a research investigator with HealthPartners, in an article in the November-December edition of the journal Health Affairs.

Despite recommendations from the federal government that insurers should cover smoking-cessation services, "After 12 months, the presence of the benefit was not associated with any change in use of bupropion, nicotine patches or nicotine gum," the article concludes. "In addition, the smoking-cessation benefit had no significant effect on attempts to quit smoking or actual quitting."

Previous randomized clinical trials have found that bupropion (Zyban) and the nicotine-replacement patches and gum are effective in getting smokers to quit, and many doctors are prescribing them with positive effect. Smoking cessation also includes counseling and other behavior-change therapies.

The government recommendation that insurance pay for drug therapy is based on four previous studies, each of which had limitation, Boyle and his colleagues contend. They note that their work is the first to measure whether simply changing insurance coverage makes a difference and the first to look at coverage for bupropion, specifically. "Ours is the only study that tested the effects of a change in coverage of medications along under circumstances likely to be used by health plans," they say.

After one year of benefit coverage, only 30 percent of smokers were aware of that coverage. Furthermore, 6 percent of those who were not covered mistakenly thought they were.

Smokers with the benefit were no more likely than those without it to report use of bupropion or the other products. Neither was there a significant difference between the two groups in their attempts to quit for even one day or to succeed for six months. In the benefits group, 40.3 percent tried to quit for one day or longer, compared to 37.8 percent of the non-benefits group. When it came to actually quitting for six months or more, 14.3 percent of the benefits group were successful, compared to 13.5 percent of the non-benefits group.

The authors say they saw no change in how physicians approached quit-smoking therapy after introduction of the benefit. "Because smokers had to obtain a prescription to use the benefit, the very limited change in physicians' behavior could help to explain why quitting attempts and rates did not change in concert with use of pharmocotherapy."

"This study provides a sobering caution to the suggestion that merely providing coverage for smoking-cessation pharmacotherapy will have a substantial effect on rates of smoking cessation," the authors say. "It is possible that if other types of cessation support were covered as well, or if greater efforts were made to make smoker members aware of the coverage, different results might be seen."
The research was conducted with support from the Robert Wood Johnson Foundation.

Health Behavior News Service: (202) 387-2829 or
Health Affairs: For copies of the article, contact Jon Gardner at (301) 656-7401, ext. 230 or

Center for Advancing Health

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