Rusty Walker, Barbara Patalsky and Greg Cooper had mixed reactions to the news that smoking cessation assistance would be free to them in 2011 under new benefits required of their health plans. Some, including Patalsky and Cooper, said they would take advantage of the free counseling or prescription drug coverage. Others, including Walker, said the reduced cost would not be an incentive to quit. (Christy Harris)
The Office of Personnel Management estimates about 18 percent of the roughly 8 million enrollees in the federal health insurance program — about 1.4 million people — are smokers. And it wants to change that.
Under new benefits, Federal Employees Health Benefits Program plans must provide for free up to four smoking cessation counseling sessions per quit attempt, for two quit attempts per year. In addition, they cannot charge co-pays for seven prescription smoking-cessation drugs or over-the-counter drugs for which members obtain a prescription. The benefits are not subject to deductibles or annual or lifetime dollar limits.
"I hope it signals that we take seriously evidence-based approaches where there's a clear documented impact of a benefit on health outcomes and costs," said Jonathan Foley, director of planning and policy analysis at OPM, which oversees the insurance program. "This to us seemed like a clear case where we should go forward."
OPM wants to remove financial barriers to quitting because "stopping smoking has the single most beneficial effect on health because of its association with many cancers, heart disease, high blood pressure and other chronic diseases," the agency said in its annual "call letter" to insurers, the start of the health plan negotiating process.
The direct medical costs associated with smoking were $96 billion a year in 2000 through 2004 in the U.S., according to the Centers for Disease Control and Prevention. Smoking also costs an estimated $97 billion a year in lost productivity due to absenteeism and other reasons, CDC reports.
Foley could not provide statistics on the costs associated with smoking specifically within FEHBP, but said the federal pool by and large mirrors the general population.
OPM expects to see a return on investment from the improved smoking cessation benefit in two to three years, he said.
"The trick here is to maximize the number of quit attempts," Foley said. OPM will track how many people use the new benefit.
Many people do not quit on their first try, he said. Eliminating cost sharing removes any financial barrier to trying. But the agency also will promote the cessation benefits to encourage more smokers to try them. "You really have to push it," Foley said.
The incentive got mixed reviews from a group of civilian Army employees on a smoke break at their Alexandria, Va., office in October.
Barbara Patalsky is excited that when she tries to quit in 2011, she can get free counseling and a prescription drug at no cost to her.
The free assistance will persuade Patalsky, a security specialist, to again try Chantix, a drug that was approved by the Food and Drug Administration in 2006. She quit for a couple months while on Chantix, and now smokes less than she used to.
This time, Patalsky, who has been smoking for 36 years, plans to try counseling along with Chantix. The drug, which acts at sites in the brain affected by nicotine, works for some, but the FDA issued an advisory in 2008 about serious potential side effects.
Though she had some nausea while using Chantix, Patalsky liked that users can continue smoking the first week. After a time, it is intended to take away the desire to smoke. The Chantix cost her about $35 for a month's supply last time she bought it, so she estimates the free benefits will save her at least $100.
Greg Cooper, an IT specialist for Army Human Resources Command, agreed the free assistance would motivate him to try quitting again. He said he probably would start with a smoking cessation class, and has already visited the website of his health plan, Kaiser Permanente, to review his options.
"I recently tried to quit on my own and failed after about one week," Cooper said.
But Rusty Walker, also an Army IT specialist, said the free help won't make a difference to him because he quit once for 10 years, just by willpower. Like other smokers who start smoking again after quitting, he said stress caused him to return to the habit. If he were to try quitting again, Walker said he would do it on his own, without classes or drugs.
Paul Jeffries, deputy director of Army publications, said he plans to try quitting someday, but the new free assistance will not be an incentive to him in the near term. Jeffries, a smoker for 42 years, said the cost of cessation assistance is not what keeps him from quitting, but the cost of cigarettes may be more of an issue after he retires.
Health plans can place conditions on the free benefits. For example, Blue Cross and Blue Shield Association's standard and basic options require members to complete a health assessment, participate in the first few parts of the company's online quitting module called "Breathe" and use preferred retail pharmacies.
Blue Cross had smoking cessation coverage before, but standard co-pays applied and over-the-counter medications were not covered.
Blue Cross, whose standard plan has the highest FEHBP enrollment, has added an incentive for completing its Blue Health Assessment, an online tool that identifies risk factors such as smoking and recommends steps to reduce them.
The incentive is a $50 reduction in the deductible in the standard plan and a $35 debit card for qualified medical expenses for the basic plan for up to two covered people in both plans.
The 2010 incentive for completing the assessment was waiving one office visit co-pay, which did significantly boost the number of people being assessed, said Jena Estes, vice president of Blue Cross' federal employee program. In the first half of 2010, more people completed the assessment than did in all of 2009, Estes said.
Waiving the cost sharing on smoking cessation benefits should entice more people to try them, Estes said. But some smokers may be more driven by awareness of the dangers of smoking or the health benefits of quitting, she said.
The American Postal Workers Union Health Plan previously offered to reimburse members up to $100 a year for smoking cessation education, marketing manager Jennifer Simon said. In 2011 under both APWU options, members can participate in a free counseling group on the phone or by e-mail; the counseling was provided through a contractor. Or they can go to outside counseling with their own doctor at 100 percent coverage, Simon said.
Prescription drugs for quitting will be free as long as members use the mail-order pharmacy, Simon said. Over-the-counter drugs can be obtained for free by contacting APWU's counseling groups, though members don't have to participate in the counseling to receive the over-the-counter drugs, she said.
Government Employees Health Association has been offering a lifetime limit of only $100 toward quitting smoking, so the new cessation benefits will be a big change. Still, GEHA estimates the expanded cessation benefits will raise rates only by 0.002 percent for its high option and 0.003 percent for standard, GEHA president Richard Miles said.
GEHA members can get the medications at non-network retail pharmacies as well as through mail-order.
The Mail Handlers Benefit Plan said in response to questions that it expects usage of the new smoking cessation benefits to be about the same as in previous years with less than 2 percent of the population taking advantage of them.