Lack of NRT coverage still a concern for Medicare patients

Tobacco treatment specialists from across the North Country met with representatives from Congresswoman Elise Stefanik’s office last month to discuss the limitations of Medicare as it relates to Nicotine Replacement Therapy.

Over-the-counter Nicotine Replacement Therapy (NRT), including nicotine patches, gum, and lozenges, are the most commonly used family of quit-smoking medications. They reduce withdrawal symptoms by providing small, controlled amounts of nicotine, without the dangerous chemicals found in cigarettes. When quit-smoking medications are combined with counseling, patients double their chances of quitting for good.

Under Medicare Part D, which patients must pay to opt-in to for prescription coverage, only one form of FDA-approved NRT is available. Medicaid, meanwhile, offers a comprehensive NRT policy.

“Individuals on Medicare, and those covered by both Medicare and Medicaid, are typically those who can’t afford the cost of over-the-counter NRT, or the 45 to 50 percent cost share associated with prescriptions like Chantix, or the nicotine inhaler under Medicare — it’s very expensive for patients,” said Danyelle Jones, program coordinator for the North Country Healthy Heart Network’s Health Systems for a Tobacco Free NY. “These high costs don’t incentivize smoking cessation. Rather, they act as a deterrent for patients with tobacco dependence who want to quit.”

Individuals with disabilities may not be able to use the nicotine inhaler, which is the one form of NRT currently covered by Medicare. Additionally, the inhaler — a Tier 4 drug — is expensive.

If Medicare adopted a policy similar to Medicaid, it would have long term positive outcomes.

“We would likely see a reduction in emergency room and urgent care visits for acute illnesses and symptoms related to chronic smoking-related diseases like COPD,” Jones said. “And we could also expect a savings for taxpayers.”

To learn more about the Heart Network’s Health Systems for a Tobacco Free NY, call (518) 891-5855 or email djones@heartnetwork.org.