Webb’s Healthy Options
Smoking Cessation Program
Medicaid Coverage Rules for Smoking Cessation Products
(EXCERPT FROM MEDICAID BULLETIN BT199933)
Reimbursement is available to pharmacy providers for smoking cessation products when prescribed by a licensed practitioner within the scope of his/her license under Indiana law.
Only patients who agree to participate in smoking cessation counseling are to receive prescriptions for smoking cessation products. The prescribing practitioner may want to have the patient sign a commitment to establish a “quit date” and to participate in counseling as the first step in smoking cessation treatment. A prescription for such products will
serve as documentation that the prescribing practitioner has prescribed or obtained assurance from the patient that counseling will concomitantly occur with the receipt of smoking cessation products.
Products covered by Indiana Medicaid include, but are not limited to:
¨ Sustained release buproprion products ( Zyban ® )
¨ Nicotine replacement drug products ( patch, gum, and inhaler )
Smoking Cessation Products
Smoking cessation products, previously mentioned herein, will be covered under the Indiana Medicaid Program for products provided on October 27, 1999 and later.
Reimbursement is available to pharmacy providers for smoking cessation products when prescribed by a licensed Practitioner within the scope of his/her license under Indiana law.
Over-the-counter smoking cessation products must still be prescribed by a licensed practitioner in order for the pharmacy to be reimbursed by Medicaid. All smoking cessation products must be prescribed by a licensed practitioner for use, along with counseling, within the twelve- (12) week treatment timeframe.
Pharmacies will bill for reimbursement according to the normal procedures as outlined in the provider manual (please see applicable provider manual section for full details).
Please Note
The Office of Medicaid Policy and Planning is hopeful that practitioners’ efforts in assisting their patients with smoking cessation will ultimately lead to a more healthy patient population. We welcome any comments you may have about this new program, which may assist our efforts to implement it practically and efficiently.
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