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SB220 | Insurance Companies Cover Smoking Cessation

SB220 mandates that Insurance Companies Cover Smoking Cessation

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The 2010 California bill, SB 220 will require that health insurance companies cover programs that would help people who smoke try and quit.

California is one of the states that is paving the way for Americans to tackle the damaging consequences of a habit that more than 45 million people in the United States are currently addicted to.

There are already bills that require California healthcare companies to cover things like in-vitro fertilization, and bone-density screening, so it’s hard to believe that a "stop smoking" bill such as SB 220 has taken this long!

Provisions include copays and OTC (Over-the-counter) medications such as nicotine gum and patches. It also includes provisions for group counseling, which is very effective for some individuals. The bill is designed to make it easier for Californians who smoke to kick the habit by making treatments available at little cost to those who wish to try.

The American Cancer Society reports that more than 1 in 4 people who try to quit smoking with the use of OTC medications are successful, which makes this bill a winner for people who are serious about quitting. And if SB 220 passes, California will become number eight in the states that have some form of smoking-cessation coverage, though it will only be number three out of the seven that require the coverage of OTC medications.

For many, the argument that people who smoke know it’s not good for them, and they therefore shouldn’t be entitled to any benefits holds no water when you consider that insurance providers already provide certain amounts of coverage for the illnesses that result from cigarette smoking such as emphysema and cancer.

Highlights from SB 220, Passed in September 2010

The Legislature finds and declares the following: (a) Providing tobacco cessation counseling and medication is one of the most clinically effective and cost-effective health services available, second only to inoculations. Tobacco cessation is five to 80 times more cost effective than pharmacologic interventions used to prevent heart attacks.

More than 70 percent of smokers wish they could quit tobacco, and each year one of every two smokers attempts to quit. However, the unassisted successful tobacco quit rate has remained constant at less than five percent. Access to counseling and pharmaceutical benefits doubles the successful quit rate and has achieved quit rates of 25 to 30 percent. Experience in health plans indicates that access to all cessation services saves four dollars ($4) for every dollar ($1) invested.

Each adult smoker costs employers one thousand seven hundred sixty dollars ($1,760) in lost productivity and one thousand six hundred twenty-three dollars ($1,623) in excess medical expenditures. Men who smoke incur fifteen thousand eight hundred dollars ($15,800) more in lifetime medical expenses than do men who do not smoke. For employers, the ultimate financial return is between five dollars ($5) and six dollars ($6) for every dollar spent on tobacco cessation.

Because of member transfers between plans, financial savings and tobacco-related disease reductions are effective only if universally available to the entire insured population. Therefore, a mandate on all plans and insurers to provide cost-effective treatment is necessary and beneficial.

It is the intent of the Legislature that this act diminish the statewide economic and personal cost of tobacco addiction by making tobacco cessation treatments available to all smokers. California has successfully reduced tobacco consumption in the last decade, but, despite that success, tobacco use is responsible for the unnecessary deaths of 40,000 residents and remains the leading cause of preventable death in this state. Annually, tobacco addiction costs California $8.6 billion in direct medical costs, which is approximately 12 percent of all health care costs.

Section 2:

(a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2011, that provides outpatient prescription drug benefits, shall include coverage for tobacco cessation services that include two courses of treatment in a 12-month period including personal counseling, which may be telephone or individual counseling, and FDA-approved medication for tobacco cessation, including prescription and over-the-counter medications. Covered treatment shall comply with the Public Health Service sponsored 2008 clinical practice guideline, “Treating Tobacco Use and Dependence: 2008 Update,” or its successors.

(b) No copayment or deductible shall be applied to benefits for over-the-counter tobacco cessation medications. Copayments for each course or treatment or prescription shall not exceed fifteen dollars ($15).

(c) A health care service plan may contract with qualified local, statewide, or national providers, whether for profit or nonprofit, for the provision of services under this section.

(d) A health care service plan shall disclose the benefits under this section in its evidence of coverage and disclosure forms and communicate the availability of coverage to all enrollees.

(e) The coverage provided pursuant to this section shall only be available upon the order of an authorized provider. Nothing in this subdivision shall preclude a plan from allowing enrollees to access tobacco cessation services on a self-referral basis.

Learn more about the bill Download PDF

Edited by Carolyn Allen


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