Medicare is investigating ways to help its beneficiaries quit smoking.
The Centers for Medicare and Medicaid Services proposed to extend smoking cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking-related disease–or who are taking certain drugs whose metabolism is affected by tobacco use.
The hope is that Medicare's decision to pay for smoking cessation counseling “will encourage and help seniors quit smoking once and for all,” Ronald Davis, M.D., trustee to the American Medical Association, said in a statement.
Of the 440,000 Americans who die annually from smoking-related disease, 300,000 are aged 65 and older, according to the Centers for Disease Control and Prevention. More than 9% of those 65 and older smoke cigarettes. The CDC in 2002 estimated that 57% of smokers aged 65 and older reported a desire to quit smoking.
The proposed coverage decision specifically applies to patients whose illness is caused or complicated by smoking, such as heart disease, cerebrovascular disease, lung disease, weak bones, or blood clots–diseases that account for the bulk of Medicare spending, according to CMS.
Beneficiaries are also eligible for counseling if they take drugs whose effectiveness is complicated by smoking, including insulins, and medicines for high blood pressure, seizures, blood clots, or depression.
Minimal counseling is already covered at each evaluation and management visit for beneficiaries. Beyond that, Medicare is proposing to cover two cessation attempts per year. “Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period,” the proposal stated.
CMS estimates the program will cost $11 million annually, a number it expects will be offset by fewer hospitalizations and health problems related to smoking.
In addition to heart disease, emphysema, and stroke, seniors who smoke cigarettes are also more likely to develop problems associated with older age, such as hip fractures, eye cataracts, and facial skin wrinkles. Seniors who try to quit smoking are 50% more likely to succeed than other age groups, and those who quit can reduce their risk of death from heart disease to that of nonsmokers within several years of quitting, Dr. Davis said.
In a statement, CMS Administrator Mark McClellan, M.D., encouraged smokers on Medicare who were starting to experience heart or lung problems, or high blood pressure “to take advantage of this new help–and more is coming.” The agency noted that Medicare's upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.
The American Lung Association supported the effort but had concerns that comparable benefits weren't available to younger patients.
The group “applauds anything that will help anyone stop smoking,” spokeswoman Diane Maple told this newspaper. However, a recent study showed that only 10% of employer-sponsored health plans cover smoking cessation programs that combine medications with counseling, she said.
The lung association hopes that private plans will follow Medicare and develop similar programs in the future, she said.
Other caregivers in comments to the agency wanted more details about the program's requirements. Only individuals trained in tobacco counseling and cessation may provide the counseling to beneficiaries, but “how will this training be accredited?” Steven White, a physician assistant, asked. “Will having a general knowledge of smoking and its risks be sufficient?”
The comment period for the proposed coverage decision closed in late January. CMS now has 60 days to review the comments and issue a final policy.