The demand for nicotine replacement therapies (NRT)
is directly related to the level of third-party coverage for NRT
products, and inversely related to out-of-pocket costs.
Individuals who face decreased out-of-pocket costs for obtaining
NRT products from either insurers or employers are more likely to
use NRT, use NRT for longer periods of time, and subsequently use
more units of NRT than individuals who face higher out-of-pocket
costs. Over-the-counter (OTC) availability of nicotine gum and
nicotine patches increased the proportion of smokers using the
patch and gum in the period immediately following approval of OTC
sale in California; there was also a significantly higher
proportion of smokers reporting abstinence through gum and patch
use in that period. Making smokers aware of insurance coverage for
a pharmacotherapy benefit (such as NRT, bupropion or varenicline)
and making it very easy to obtain the medication increases use of
the medication and quit rates, even in the absence of insurance
coverage for behavioral counseling. However, simply providing
coverage for pharmacotherapy, without efforts to make smokers aware
of the covered benefit and making it easy to obtain, was not shown
to increase the use of medication and quit rates.
Cox JL, McKenna JP. Nicotine gum: Does
providing it free in a smoking cessation program alter success
rates. J Fam Pract. 1990; 31: 278-280.
Curry SJ, Grothaus LC, McAfee T, Pabiniak C.
Use and cost effectiveness of smoking-cessation services under four
insurance plans in a health maintenance organization. N Engl J Med.
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Hughes JR, Wadland WC, Fenwick JW, Lewis J, Bickel WK.
Effects of cost on the self administration and efficacy of nicotine
gum: a preliminary study. Prev Med. 1991; 20: 486-496.
Johnson RE, Hollis JF, Stevens VJ, Woodson GT.
Patterns of nicotine gum use in a health maintenance organization.
Ann Pharmacother. 1991; 25: 730-735.
Solberg LI. Impact of insurance coverage on the
use and effects of smoking cessation medications. Dis Manage Health
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