March is here, which means we’re two months in to our New Year’s resolutions and goals! We suspect that you have goals to live healthier lifestyles! In many cases, the first step toward a healthy lifestyle is to give up bad habits like smoking.
As you know, smoking can lead to numerous complications and preventable deaths. Are you ready to help stick to your New Year’s resolutions? We’re ready and we’re here to help!
Who it Covers:
The Affordable Care Act (ACA) mandates coverage of tobacco cessation products for members participating in non-grandfathered plans purchased after March 23, 2010. This coverage is already in effect for members with grandfathered plans purchased before March 23, 2010 and ACA plans.
Please note: Product coverage applies to BCBS-SC Individual and Group plan holders.
How it Works:
BlueCross Blueshield of South Carolina will cover certain tobacco cessation products at zero ($0) member cost share . BCBS-SC developed the program based on accepted national smoking cessation treatment guidelines. Members participating in non-Marketplace plans will need to request prior authorization for coverage of these drugs in order to promote the safe and cost-effective use of the available therapies.
The tobacco cessation drugs covered at zero member cost share ($0) are:
Prescription-only bupropion 150mg (generic Zyban)
Prescription-only nicotine nasal spray or inhalers (ex: Nicotrol NS and Nictorol inhaler)
Over-the-counter (OTC) nicotine patches/transdermal systems (ex.: Habitrol OTC and Nicoderm CQ OTC)
OTC nicotine gum (ex.: Nicorette gum OTC)
OTC nicotine lozenges (ex.: Nicorette lozenge OTC and Nicorette mini lozenge OTC)
Requirements for Coverage
Member must be 18 years old
Coverage for Chantix, prescription-only nicotine nasal spray or nicotine inhaler require members complete unsuccessful trial or experience an adverse reaction during the trial of both of the following products:
One of the available OTC nicotine replacement products (note: OTC nicotine trial must be documented in prescription history)
Length of Treatment:
BCBS-SC will limit prescription fills for any of these products to a 30-day/one-month supply at a time. The maximum is 90 days/three months per approval. When appropriate, members can request reauthorization to continue treatment for an additional 90 days/three months of therapy. This cannot exceed two 90-day/three-month periods of smoking cessation therapy per 365 days/12 months.
Tobacco Cessation Counseling:
Quit rates are highest when you pair tobacco cessation counseling and nicotine replacement therapies together. BlueCross Blueshield of South Carolina health coaches use motivational interviewing to help members decide when and how to quit. They will provide ongoing support to help members become tobacco free. Members with non-grandfathered plans can enroll by calling 855-838-5897, option 2. Members with ACA plans can enroll by calling 800-327-3183, ext. 25805.
BlueCross Blueshield of SC members can find information about their pharmacy coverage for all drugs, including tobacco cessation, by logging into My Health Toolkit®. Under Benefits, they can select Prescription Drugs to see benefit coverage for a specific drug.