People who purchased health insurance through the state healthcare exchange and who want to quit smoking are entitled to free medications and services — even if their insurer doesn’t appear to want them to know about it.
That was the message from Sen. Richard Blumenthal, who joined forces Wednesday with heart and lung care advocates in Hartford to call upon ConnectiCare and United Healthcare to halt “unfair and potentially illegal” practices that prevent people from getting the help they need to stop smoking.
Blumenthal said two out of four insurers on Connecticut’s insurance exchange have not complied with federal healthcare exchange guidelines when it comes to the availability of smoking cessation medications and counseling.
The Affordable Care Act requires health insurance plans purchased through federal and state exchanges to cover certain preventive products and services with no co-pay or deductible. That coverage must be granted automatically, without prior approval.
The August 2015 update of a report by the American Lung Association shows that ConnectiCare’s list of approved drugs available free of charge does not include nicotine lozenges, nicotine nasal spray, or nicotine inhalers. The report also found that information on the insurance company’s tobacco cessation website does not match the list of approved drugs.
In a statement, ConnectiCare it is in compliance with all federal and state coverage requirements.
“The Connecticut Department of Insurance has approved our plans as being compliant,” the company said.
The same American Lung Association report cited United Healthcare, based in Georgia, for not automatically covering medications outlined in ACA guidelines. The insurer requires prior authorization for all seven FDA-approved tobacco cessation medications.
A statement from United Healthcare failed to address the prior authorization allegations, instead focusing on the fact that it offers medications and services without a copay or deductible.
“UnitedHealthcare covers tobacco cessation products and tobacco cessation screening and counseling at no cost sharing in accordance with Affordable Care Act guidelines and essential health benefit requirements,” the statement said. “These benefits are available on plans offered on and off federal and state exchanges.”
Blumenthal said he will ask authorities at the state and federal level to take action if the insurance companies do not comply with the guidelines. Another option would be to initiate hearings or oversight procedures in the U.S. Senate, he said.
State Healthcare Advocate Victoria Veltri said proper compliance is as simple as letting people know what services are available to them through the health insurance marketplace.
“What that means is not really burying the coverage in a plan document, but actually listing the kind of preventative services that are covered by the Affordable Care Act,” Veltri said.
Angelina Stackpole, who is with the Connecticut chapter of the American Heart Association, said making that information available is important because it can save people’s lives while at the same time saving the state money.
“Within the first two years of the implementation of a similar benefit in Massachusetts, the state saw a 10-percent decrease in the smoking rate among the state’s Medicaid population,” Stackpole said.
According to Stackpole, the smaller population of smokers led to fewer hospitalizations for heart attacks and a reduced need for expensive, smoking-related healthcare services. “The declines were found to save the Massachusetts health program $10.5 million, or just over $3 for every dollar spent,” she said.
Statistics from the Campaign for Tobacco Free Kids show the population of adult smokers in Connecticut came in at 15.5 percent in 2014. Among high school students, 13.5 percent were smokers.
There are approximately 4,900 deaths from smoking per year in Connecticut.