Holy cow!

Welcome to Chicago everybody!

"Take me out to the ball game,Take me out with the crowd.

Buy me some peanuts and Cracker Jack,I don't care if I never get back,

So lets root, root, root for the Cubbies,If they don't win it's a shame.

For it's one, two, three strikes, you're out,

At the old ball game."

StateTobacco

Cessation Policy Update

Matt Barry

Campaign for Tobacco Free Kids

May 4, 2005

Chicago, IL

Today’s Keen Insights

• Medicaid

• Private Insurance

• Excise Taxes

• Smokefree Laws

• Technical Assistance

• Make It Your Business

Current CMS Policy On Cessation: Medicaid

General Policy -

• Smoking cessation benefits, such as counseling and drug therapy, are optional benefits under Medicaid (except for kids covered under EPSDT).

• Smoking cessation drugs are specifically classified as those drugs that may be excluded from coverage under Medicaid.

• Smoking cessation counseling services may be provided under a variety of Medicaid benefit categories.

Pregnant Women - There are no mandatory smoking cessation benefits for pregnant women under Medicaid. A state may elect to provide smoking cessation services in a State plan.

Number of State Medicaid Programs Covering Tobacco Dependence

Treatments (N=51), 2003

45Telephone Counseling

1110Group Counseling

1417Individual Counseling

2726Gum

2827Patch

2728Nasal Spray & Inhaler

3640Zyban

20032002Tobacco Dependence Treatment

Source: Halpin, HA, MMWR, January 30, 2004 / 53(03);54-57.Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, 2003. http://statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid.

Informing Medicaid Tobacco Users about Benefits, 2003

Methods for Informing Medicaid Recipients

# States 2002

# States 2003

Inform tobacco users about benefits 9 18

Through primary care provider 5 8

Mailer 5 6

Newsletter/magazine 3 4

Television spots 3 3

Member services/information line 3 8

Website 2 3

New member packet 2 8

Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, 2003. http://statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid.

COVERAGE CONSISTENT WITH PHS GUIDELINES

Source: Halpin, HA, MMWR, January 30, 2004 / 53(03);54-57.

9 States Offer Comprehensive* Coverage:

• California

• Indiana

• Maine

• Minnesota

• New Jersey

• New York

• Oregon

• Pennsylvania

• West Virginia

* = Zyban, NRT Gum, Patch, Nasal Spray, Inhaler, and at least one type of counseling (individual, group or proactive telephone).

States with Private Insurance Mandates for Cessation

• New Mexico – Mandates coverage of both pharmacotherapy and counseling for all private health plans in the state (effective March 1, 2004).

• Maryland – Mandates coverage of prescription NRTs for all private health insurance in the state (passed by legislature April 2005).

• California (?) – There is a bill pending before the CA legislature to mandate private health plan coverage of pharmacotherapy and counseling services.

STATE AND LOCAL POLICIES AND

PROGRAMSTHAT MAXIMIZE

TOBACCO CESSATION

TOBACCO EXCISE TAXES

“The single most direct and reliable method for reducing consumption is to increase the price of tobacco products, thus encouraging the cessation and reducing the level of initiation of tobacco use.”

- National Academy of Sciences, Institute of Medicine, 1998

“It is clear that price has a pronounced effect on the smoking prevalence of teenagers and that the goals of reducing teenage smoking and balancing the budget would both be served by increasing the Federal excise tax on cigarettes.”

- Myron Johnson, Philip Morris Research Executive, 1981

EFFECTS OF A 10% INCREASE IN THE TOBACCO TAX

• Nearly 7% decline in youth prevalence

• A 2% decline in adult prevalence

• A 4% decline in overall consumption

CALIFORNIA

NEVADA

80

OREGON

118

WASHINGTON

142.5

ARIZONA

118NEW MEXICO

91

TEXAS

41

OKLAHOMA

103

UTAH

69.5 COLORADO

84KANSAS

79

NEBRASKA

64

IDAHO

57

MONTANA

170NORTH DAKOTA

44

SOUTH DAKOTA

53

MINNESOTA

48

IOWA

36

MISSOURI

17

ARKANSAS

59

36

LOUISIANA

MS

18

ALABAMA

42.5GEORGIA

37

FLORIDA

33.9

SOUTH CAROLINA

7

NORTH CAROLINA5TENNESSEE

20

KENTUCKY30

ILLINOIS

98

WISCONSIN

77MICHIGAN

200

IN

55.5

OHIO

55WV55

30VIRGINIA

PENNSYLVANIA

135

NEW YORK150

MAINE100

VTNH:52

MA

CT:151RI:246

NJ:240

DELAWARE:55

MARYLAND:100DC:100

HAWAII

140

ALASKA

160

States that have recently passed or implemented a cigarette tax increase (since 1/1/2002)

WYOMING

60

April 5, 2005

Recent Cigarette Tax Increases

CT

MA:151

87

VT:119

Oregon actually decreased its cigarette tax by 10 cents on 1/1/04.Kentucky’s tax rate increases from 3 to 30 cents on 6/1/05; Virginia’s tax rate increases from 20 to 30 cents on 7/1/05.

The Pennsylvania Tax ExperienceFrom .31 to 1.00 on 7/15/02

$320.1Million

$827.8Million

$0

$200,000,000

$400,000,000

$600,000,000

$800,000,000

$1,000,000,000

7/01 - 6/02 7/02 - 6/03

Revenue

-14.0%Packs Sold

+158.6%

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

7/01 - 6/02 7/02 - 6/03

1.07Billion

917.7Million

The Indiana Tax ExperienceFrom .155 to .555 on 7/1/02

$110.3Million

$338.2Million

$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

7/01 - 6/02 7/02 - 6/03

Revenue

-16.7%Packs Sold

+206.5%

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

7/01 - 6/02 7/02 - 6/03

742.1Million 617.9

Million

The Kansas Tax ExperienceFrom .24 to .79*

$47.9Million

$116.2Million

$0

$50,000,000

$100,000,000

$150,000,000

7/01 - 6/02 7/02 - 6/03

Revenue

-21.6%

Packs Sold

+142.7%

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

7/01 - 6/02 7/02 - 6/03

208.8Million

163.7Million

*KS raised its cigarette tax from .24 to .70 on 7/1/02 and then to 79 on 1/1/03

The New York City Tax ExperienceFrom .08 to 1.50 on 7/01/02

$27.38Million

$278.01Million

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

7/01 - 6/02 7/02 - 6/03

Revenue

-45.8%Packs Sold

+915.1%

0

100,000,000

200,000,000

300,000,000

400,000,000

7/01 - 6/02 7/02 - 6/03

342.35Million

185.34Million

SMOKEFREE WORKPLACE

LAWS

100 MILLION PEOPLE!!

Smoke free workplace laws:

Prompt more smokers to try to quit; Increase the number of successful quit

attempts; Reduce the number of cigarettes that

continuing smokers consume; and Discourage kids from ever starting to

smoke.

The U.S. Surgeon General has concluded that smoke free laws

“… have been shown to decrease daily tobacco consumption and to increase smoking cessation among smokers.”

[Source - U.S. Department of Health and Human Services (HHS), Reducing Tobacco Use: A Report of the Surgeon General, 2000]

The National Cancer Institute concluded that:

“… workplace smoking restrictions areaccompanied by an increase in cessation

attempts and a reduction in number of cigarettes smoked per day by continuing smokers.”

[Source - National Cancer Institute, Population Based Smoking Cessation: Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control Monograph No. 12, NIH Pub. No. 00-4892, November 2000]

WHAT DO GOVERNMENT HEALTH AUTHORITIES SAY?

QUITLINES

WHERE ARE THE QUITLINES AND WHO

RUNS THEM?

• 44 states are covered by 38 quitlines

• 36 state-managed quitlines• 5 states have formal agreement

with Federal quitline service• 3 states receive quitline service

from Legacy• 2 states announcing “request for

proposals” • 5 states without formal

arrangement for quitline services

For more information on quitlines, see:

http://www.naquitline.org/

or

http://www.smokefree.gov/

CALL VOLUME TO 1-800-QUITNOWAccording to data gathered by MCI for the National Cancer Institute’s Cancer Information Service, calls to the national portal number, 1-800-QUITNOW, have been as follows for the period November 2004 - March 2005:

November 2004 – 2,243

December 2004 – 5,883

January 2005 – 7,821

February 2005 – 9,505

March 2005 – 11,714

Total* – 37,166

* Ohio uses the 1-800-QUITNOW number as its state quitline number and has done extensive promotions of the number. As a result, Ohio accounts for 23,641 of all calls to the national portal number (64%). In addition, neighboring States of Kentucky and West Virginia (which share media markets), accounted for 2,081 (5.6%) and 1,915 (5.2%) calls respectively.

EXAMPLES OF OTHER STATE AND

LOCAL ACTIVITY

TECHNICAL ASSISTANCE FOR MEDICAID CESSATION

PROJECT

Toolkit Contains Information On -

• Actions states can take now to provide coverage (administrative actions to changes in statute).

• The clinical benefits of cessation.• Calculating state-specific costs/savings due to cessation

services.• Joint CDC-CMS document on the cost effectiveness of

cessation and clinical benefits.• Case studies of how states have implemented effective

programs.• Tips for coordinating between Medicaid and other state

agencies.• Basic terminology for Medicaid.• Tobacco's toll on Medicaid budgets and health impact.

Follow-Up to Release of Medicaid Toolkit

• TA Group Consists Of: TFK, CTC, MoD, AMCHP, Porter Novelli, Smokefree Families, and CDC.

• Conference calls with state program managers, health departments, tobacco control coalitions.

• Identification of target states for possible outreach and policy activity.

• Working with several states, including Pennsylvania, Kentucky, Alaska, Massachusetts and others.

• Resulted in actual Medicaid benefit changes in PA and KY.

Make It Your Business

• Tobacco-Free Coalition of Oregon• Based on the idea: Oregon businesses would

pay far less to prevent tobacco-related diseases than to treat them (based on an actuarial study)

• Toolkit to Help Employers• Step-by-step guide for businesses to insure a

tobacco-free workforce and to promote tobacco cessation benefits and services.

• www.tobaccofreeoregon.org