Tobacco Cessation Treatment and the ACA’s Preventive Care Mandate

The Affordable Care Act (ACA) requires non-grandfathered healthcare plans to supply enrollees with a wide variety of preventive care benefits at no out-of-pocket cost. One preventive care mandate is counseling and intervention (apparently at the primary care level) regarding tobacco use.

A frequent question we receive is, “Does this intervention include smoking cessation drugs? Is the plan required to supply such drugs at no out-of-pocket cost to the enrollee?”

We have assumed the answer is “yes,” because the clinical guidelines on which the tobacco cessation intervention mandate is based allude to pharmacological intervention. Federal authorities have now clarified this point, in a recent series of FAQs related to the ACA, and reach the same conclusion. The relevant FAQ provides:

 [A] group health plan…[will] be in compliance with the requirement to cover tobacco use counseling and interventions, if, for example, the plan…covers without cost-sharing:

1. Screening for tobacco use; and
2. For those who use tobacco products, at least two tobacco cessation attempts per year.

 For this purpose, covering a cessation attempt includes coverage for:

•  Four tobacco cessation counseling sessions of at least 10 minutes each (including telephone counseling, group counseling and individual counseling) without prior authorization; and
• All Food and Drug Administration (FDA)-approved tobacco cessation medications (including both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by a health care provider without prior authorization.