MMWR Morb Mortal Wkly Rep. 2010 Oct 22;59(41):1340-3.
Medicaid enrollees have nearly twice the smoking rates (37%) of the general adult population (21%), and smoking-related medical costs are responsible for 11% of Medicaid expenditures. In 2008, the Public Health Service released clinical practice guidelines recommending comprehensive coverage of effective tobacco-dependence medications and counseling by health insurers. Healthy People 2010 established a clear objective for Medicaid programs to cover all Food and Drug Administration--approved medications and counseling for tobacco cessation. To monitor progress toward that objective, the Center for Health and Public Policy Studies at the University of California, Berkeley, in collaboration with CDC, surveyed Medicaid programs in the 50 states and the District of Columbia (DC) to document their 2009 tobacco-dependence treatment coverage and found that 47 programs offered coverage. Only eight state programs offered coverage of all recommended pharmacotherapy and counseling for all Medicaid enrollees, and 16 programs reported coverage for fee-for-service enrollees that differed from that provided for Medicaid managed-care enrollees. Among the 33 programs that covered at least one combination therapy, the nicotine patch plus bupropion slow release (SR) was the one combination covered by all. The Affordable Care Act mandates Medicaid coverage of tobacco-dependence treatments for pregnant women, beginning October 1, 2010. Coverage of pharmacotherapy for all Medicaid enrollees will be enhanced by January 2014, when states no longer may exclude tobacco-dependence cessation drugs from covered benefits. Monitoring the extent to which Medicaid programs place limitations on these treatments can help in evaluating accessibility of tobacco-dependence treatments to Medicaid enrollees.
医疗补助计划的参保人吸烟率（37%）几乎是普通成年人的两倍（21%），而与吸烟有关的医疗费用占医疗补助计划支出的 11%。2008 年，美国公共卫生署发布了临床实践指南，建议健康保险公司全面涵盖有效的烟草依赖药物和咨询服务。《健康人民 2010 年》为医疗补助计划设定了一个明确的目标，即为所有食品和药物管理局批准的烟草戒断药物和咨询提供覆盖。为了监测实现这一目标的进展情况，加州大学伯克利分校健康与公共政策研究中心与疾病预防控制中心合作，对 50 个州和哥伦比亚特区（DC）的医疗补助计划进行了调查，记录了他们在 2009 年的烟草依赖治疗覆盖情况，发现有 47 个计划提供了覆盖。只有 8 个州计划为所有医疗补助计划的参保人提供所有推荐的药物治疗和咨询服务，有 16 个州报告了为服务对象提供的覆盖范围，与为医疗补助计划管理式医疗参保人提供的服务不同。在至少覆盖一种联合治疗方案的 33 个计划中，尼古丁贴片加安非他酮缓释（SR）是所有计划都涵盖的一种联合治疗方案。《平价医疗法案》要求从 2010 年 10 月 1 日起，为孕妇提供医疗补助计划的烟草依赖治疗。到 2014 年 1 月，所有医疗补助计划的参保人都将增加药物治疗的覆盖范围，届时各州不得将烟草依赖戒断药物排除在保险范围之外。监测医疗补助计划对这些治疗方案的限制程度，有助于评估烟草依赖治疗方案对医疗补助计划参保人的可及性。
