Minnesota and South Carolina are at the top of the class for access to smoking cessation services, but a new report card from the American Lung Association shows that the treatment coverage in most states earned barely passable or failing grades.

In fact, 31 states received either a D (11 states) or an F (20 states) on the grading system. There were also 11 C’s and 7 B’s to go along with the two A’s, the ALA said in “State of Tobacco Control 2018.”

The cessation coverage grades are based on a 70-point total, with a maximum of 40 points awarded for a state’s Medicaid coverage (smoking rates are much higher and incomes lower among Medicaid enrollees than the general population), 20 points for the investment per smoker in the state’s phone quitline, and 10 points for state employee health plan coverage.

Minnesota received 66 points and South Carolina earned 63 after a 5-point deduction for not expanding Medicaid up to Affordable Care Act standards. The highest-finishing states with B’s were Vermont with 62 points and Maine with 61, and the lowest total score was the 23 points earned by Virginia and Washington, although Washington’s grade did not include the state employee category since the state did not provide data on its plan, the ALA noted.

The Department of Health & Human Services recommends that tobacco cessation coverage include the use of five nicotine-replacement therapies (gum, patch, lozenge, nasal spray, inhaler), bupropion and varenicline (nonnicotine medications), and three types of counseling (individual, group, and phone), the report said.

“It’s imperative that all state Medicaid programs cover a comprehensive tobacco cessation benefit, with no barriers, to help smokers quit, including all seven [Food and Drug Administration]–approved medications and three forms of counseling for Medicaid enrollees. In 2017, only Kentucky, Missouri, and South Carolina provided this coverage,” wrote Harold P. Wimmer, national president and CEO of the ALA.

rfranki@frontlinemedcom.com

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