Provide coverage for evidence-based tobacco-cessation treatments (counseling and FDA-approved prescription and nonprescription medications), at either no cost or at a reasonable cost-sharing level, for all employees and covered dependents enrolled in the employer’s health plans.
Gold Standard employers provide coverage for FDA-approved products to ensure cost is not a barrier in pursuing the most effective therapy for each individual tobacco user.
FDA-approved tobacco cessation medications have all been evaluated to be safe and effective products, and sort into two categories: Nicotine Replacement Therapy (NRT) and non-nicotine over-the-counter (OTC) medications. Several factors affect what will work best for each smoker or other tobacco user, however, so there is no selection of only certain FDA-approved medications that make sense for all or even most individuals.
The different NRTs work by the same broad principle of providing nicotine at controlled doses. However, they vary in the methods of delivery and the ways they are absorbed and interact with body chemistry. Non-nicotine medications work through different sets of biochemical and physical interactions inside a person’s body. Meanwhile, individuals have unique medical histories, tobacco use histories, body chemistry profiles, tolerances for side effects, other medications they take, and patterns of daily life at work and at home.
Cessation can be a challenging process for any tobacco user. When employers provide access to FDA-approved medications, individuals and their health care providers can seek out the most effective treatment match.
Coverage for the following FDA approved tobacco cessation medications are required:
- Prescription Only (Rx): Bupropion SR 150 (generic or Zyban or Wellbutrin SR)
- Prescription Only (Rx): Varenicline (Chantix)
- Over the Counter/OTC/Nonprescription: Nicotine Gum (generic or Nicorette)
- Over the Counter/OTC/Nonprescription: Nicotine Lozenge (generic or Commit)
- Over the Counter/OTC/Nonprescription: Nicotine Patch (generic or Nicoderm CQ or Nicotrol)
Coverage for the following FDA approved tobacco cessation medications are optional:
- Prescription Only (Rx): Nicotine Inhaler (Nicotrol inhaler)
- Prescription Only (Rx): Nicotine Nasal Spray (Nicotrol NS)
Medications must be available at either no cost or with a co-pay that is line with your other pharmacy benefits. In cases where a generic form of a medication is available, you may choose to provide access to the generic and not the brand.
Provide employer-sponsored tobacco-cessation programming and/or services.
An organization must have programming in place to encourage employees to quit and remain tobacco free. The application provides many suggested ways to meet this requirement, not all required. However, you’ll be required to check off a sufficient number of boxes to demonstrate that programming is in place to help employees quit the use of tobacco. When evaluating your application, the Accreditation Review Board (ARB) will take into consideration your organizations size, number of locations and industry.
