Medicaid coverage and utilization of covered tobacco-cessation treatments: the Arkansas experience.

BACKGROUND: Although most Medicaid programs have some coverage for tobacco-cessation treatments, little is known about how well the covered treatments are utilized among Medicaid enrollees.
PURPOSE: To 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.
METHODS: This 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.
RESULTS: By 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.
CONCLUSIONS: Medicaid coverage alone may have limited sustained effect on increasing utilization of the covered tobacco-cessation treatments among Medicaid enrollees.