Medicaid coverage for FDA-Approved Nicotine Cessation Medication

Effective January 1, 2020 – Nicotine cessation products will no longer require prior authorization. Patients are still strongly encouraged to sign up for counseling through NDQuits as nicotine cessation is significantly more successful with a counseling component than with medication alone. The patient must be compliant with treatment. Chantix treatment can be extended to 24 weeks of continuous treatment if the patient is abstinent.

What medications are covered?

  • Nicotine patch (7mg, 14mg, 21mg)
  • Nicotine gum (2mg and 4mg)
  • Nicotine lozenge (2mg and 4mg)
  • Nicotine inhaler
  • Nicotine nasal spray
  • Bupropion
  • Chantix

What medication therapies are covered?

  • Chantix and Nicotine patch is allowed for 12 weeks every 6 months and is allowed with all other products
  • Nicotine Gum, Lozenge, Inhaler, and Spray are allowed for 90 days every 6 months. They must be used with Nicotine Patch, Chantix, or Bupropion
  • Bupropion is allowed for 90 days every 6 months and is allowed with all other products.

How do you access the medications?

Contact your doctor to discuss which medication therapy might work best for you. Your provider must write a prescription to receive cessation medications.

Source: Coverage Rule and PDL Updates for 2020