Smokers trying to quit have a hard time getting help
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With higher taxes on cigarettes, more restrictive "clean air" legislation and now tighter regulation of tobacco, smokers have never had more reason to quit -- and many are lining up to do just that. One local smoke cessation program reports a 41 percent increase in enrollments this year alone.
"Unfortunately, a fair number of people we are seeing in the program tend to be folks who are dramatically underinsured or don't have insurance to begin with," said Cindy Thomas, executive director for Tobacco Free Allegheny.
As it turns out, even having insurance may not be enough.
Despite the well-documented health and cost benefits of quitting, most insurance coverage falls short of federal Centers for Disease Control and Prevention recommendations for helping smokers quit, according to the American Lung Association.
Among southwestern Pennsylvania insurers, only the UPMC Health Plan matches the CDC recommendations for a comprehensive smoke cessation program.
The center recommends at least four counseling sessions of at least 30 minutes each; coverage for both prescriptions and over-the-counter nicotine replacement medication; counseling and medication coverage for at least two smoking cessation attempts each year; and no or minimal co-payments and deductibles for counseling and medications.
UPMC Health Plan members have access to a program offering six counseling sessions, "and members can re-enroll as many times as they need to" at no added charge, said Tim Cline, the plan's senior director of clinical training and development.
There also is unlimited access to a health coach and coverage for medications, with small co-payments, including FDA-approved over-the-counter medications if employers choose that plan.
"We appreciate that quitting smoking is one of the most important things a person can do to improve [his or her] health status," said Mr. Cline, adding that the 5-year-old program has a successful quit rate of 13 percent to 27 percent, depending on which treatment members select.
Blue Cross of Northeastern Pennsylvania in Wilkes-Barre, which also follows CDC recommendations, tailors programs to individual members, with a focus on social support and coverage for aids such as nicotine replacement patches. Officials there say they had a quit rate of 40 percent in 2008.
Other major plans locally, such as Highmark and UnitedHealthcare, have smoke cessation programs that include parts, but not all, of the Centers for Disease Control recommendations.
They do include counseling, online programs or telephone access to a counselor. The CDC does say smokers are more likely to use telephone counseling rather than individual or group counseling sessions.
Highmark members also may receive coupons to defray the cost of nicotine replacement patches or other medications.
UnitedHealthcare does not cover prescription medications, said Stephanie Bernaciak, vice president of the Western Pennsylvania region. "There are too many questions about the outcomes and different side effects that occur with those medications."
Highmark officials say their programs have a quit rate ranging from 20 percent to 25 percent. UnitedHealthcare says more than half of the members who participate in its cessation program quit smoking for up to six months.
Proponents of smoke cessation programs say it is critical that the full array of options is available once someone decides to quit.
"If you look at the menu of services or treatment, there are pieces of a comprehensive program provided but I'm not sure a comprehensive approach is provided," said Deborah Brown, acting CEO for the American Lung Association's Mid-Atlantic regional office in Harrisburg.
"We know it takes people several attempts before they quit smoking. If you have only one or two of those things, you get a patchwork approach."
CDC estimates 23 percent of adults and 28 percent of teens smoke, and while the majority want to quit, "few succeed without help."
Shari Binkney,47, of West Mifflin, started smoking in seventh grade and finally quit one year ago on her third attempt. She said her insurance covered one medication to stop the cravings but only after she could show that she'd tried and failed to quit once already.
"When you quit and then start up again, it doubles how much you smoke," making it that much harder to quit the next time, she said.
She finally stopped, with help from Tobacco Free Allegheny, after being diagnosed with emphysema. The rising cost of smoking -- a 62 cents per pack tax was added earlier this year -- also was a factor.
"But it was more for my two grandchildren," she said. "I want to see them grow up."
Putting an effective program together can be tricky. On average, smokers need five to seven attempts at quitting before they're successful. "Sometimes, for whatever reason, people just aren't ready," said Ms. Thomas.
The lung association's Ms. Brown advocates that comprehensive smoke cessation programs laid out by the CDC should be part of every basic health care package.
It's not just individuals who need to take the initiative, she said, or just employers or just insurers. "The three entities really need to simultaneously work together to make this happen."
First Published June 19, 2009 12:00 am
