title: Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.
abstract: OBJECTIVE
  To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes.
  
  
  METHODS
  We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding.
  
  
  RESULTS
  In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization.
  
  
  CONCLUSIONS
  Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0001-6202-1075
authors.initials: J
authors.lastname: Kahende
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Ann
authors.identifier: http://orcid.org/0000-0001-6202-1075
authors.initials: A
authors.lastname: Malarcher
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Lucinda
authors.initials: L
authors.lastname: England
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Biostatistics Inc., Sarasota, Florida, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Mowery
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Biostatistics Inc., Sarasota, Florida, United States of America.
authors.forename: Varadan
authors.initials: V
authors.lastname: Sevilimedu
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Italia
authors.initials: I
authors.lastname: Rolle
mesh_terms: D000293:Adolescent; D000328:Adult; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D016540:Smoking Cessation / Q000191:economics*; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D014481:United States; D055815:Young Adult