Cessation for Adult Patients

• Home
• NYS Quitsite

NYS Medicaid Smoking Cessation
Coverage Highlights

1. Smoking cessation therapy consists of prescription and non-prescription agents. Covered agents include nasal sprays, inhalers, Zyban (bupropion), Chantix (varenicline), over-the-counter nicotine patches and gum.
2. Two courses of smoking cessation therapy per recipient, per year are allowed. A course of therapy is defined as no more than a 90-day supply (an original order and two refills, even if less than a 30 day supply is dispensed in any fill).
3. If a course of smoking cessation therapy is interrupted, it will be considered one complete course of therapy. Any subsequent prescriptions would then be considered the second course of therapy.
4. Some smoking cessation therapies may be used together. Professional judgment should be exercised when dispensing multiple smoking cessation products.
5. Duplicative use of any one agent is not allowed (i.e., same drug/same dosage form/same strength).
6. For all smoking cessation products, the recipients must have an order. A prescription is the terminology for an order of a prescription product. A fiscal order refers to an order, which looks just like a prescription–written on a prescription blank, for an over-the-counter product.
7. Prescription nicotine patches will no longer be reimbursed. NYS Medicaid will only reimberse for over-the-counter patches.
   
   
   

   Information provided by the Office of New York Medicaid 1/07