abstract: 'Background: Insurance coverage of tobacco cessation medications

  increases their use and reduces smoking prevalence in a population.

  However, uncertainty about the impact of this coverage on health care

  utilization and costs is a barrier to the broader adoption of this

  policy, especially by publicly funded state Medicaid insurance programs.

  Whether a publicly funded tobacco cessation benefit leads to decreased

  medical claims for tobacco-related diseases has not been studied. We

  examined the experience of Massachusetts, whose Medicaid program adopted

  comprehensive coverage of tobacco cessation medications in July 2006.

  Over 75,000 Medicaid subscribers used the benefit in the first 2.5

  years. On the basis of earlier secondary survey work, it was estimated

  that smoking prevalence declined among subscribers by 10\% during this

  period.

  Methods and Findings: Using claims data, we compared the probability of

  hospitalization prior to use of the tobacco cessation pharmacotherapy

  benefit with the probability of hospitalization after benefit use among

  Massachusetts Medicaid beneficiaries, adjusting for demographics,

  comorbidities, seasonality, influenza cases, and the implementation of

  the statewide smoke-free air law using generalized estimating equations.

  Statistically significant annualized declines of 46\% (95\% confidence

  interval 2\%-70\%) and 49\% (95\% confidence interval 6\%-72\%) were

  observed in hospital admissions for acute myocardial infarction and

  other acute coronary heart disease diagnoses, respectively. There were

  no significant decreases in hospitalizations rates for respiratory

  diagnoses or seven other diagnostic groups evaluated.

  Conclusions: Among Massachusetts Medicaid subscribers, use of a

  comprehensive tobacco cessation pharmacotherapy benefit was associated

  with a significant decrease in claims for hospitalizations for acute

  myocardial infarction and acute coronary heart disease, but no

  significant change in hospital claims for other diagnoses. For

  low-income smokers, removing the barriers to the use of smoking

  cessation pharmacotherapy has the potential to decrease short-term

  utilization of hospital services.'
affiliation: 'Land, T (Corresponding Author), Massachusetts Tobacco Cessat \& Prevent
  Program, Boston, MA USA.

  Land, Thomas; Paskowsky, Mark; Warner, Donna; Kwass, Jo-Ann; Keithly, Lois, Massachusetts
  Tobacco Cessat \& Prevent Program, Boston, MA USA.

  Rigotti, Nancy A.; Levy, Douglas E., Massachusetts Gen Hosp, Dept Med, Tobacco Res
  \& Treatment Ctr, Div Gen Med, Boston, MA 02114 USA.

  Rigotti, Nancy A.; Levy, Douglas E., Harvard Univ, Sch Med, Boston, MA USA.

  Rigotti, Nancy A.; Levy, Douglas E., Massachusetts Gen Hosp, Mongan Inst Hlth Policy,
  Boston, MA 02114 USA.

  Wetherell, LeAnn, Off Medicaid Commonwealth Massachusetts, Boston, MA USA.'
article-number: e1000375
author: Land, Thomas and Rigotti, Nancy A. and Levy, Douglas E. and Paskowsky, Mark
  and Warner, Donna and Kwass, Jo-Ann and Wetherell, LeAnn and Keithly, Lois
author-email: Thomas.Land@state.ma.us
author_list:
- family: Land
  given: Thomas
- family: Rigotti
  given: Nancy A.
- family: Levy
  given: Douglas E.
- family: Paskowsky
  given: Mark
- family: Warner
  given: Donna
- family: Kwass
  given: Jo-Ann
- family: Wetherell
  given: LeAnn
- family: Keithly
  given: Lois
da: '2023-09-28'
doi: 10.1371/journal.pmed.1000375
files: []
issn: 1549-1277
journal: PLOS MEDICINE
keywords-plus: 'ACUTE MYOCARDIAL-INFARCTION; CORONARY-HEART-DISEASE; SMOKING-CESSATION;

  UNITED-STATES; QUITTING SMOKING; HEALTH; RISK; MORTALITY; EXPOSURE;

  CHARGES'
language: English
month: DEC
number: '12'
number-of-cited-references: '25'
orcid-numbers: Levy, Douglas/0000-0001-9446-7899
papis_id: edd46f9594462421edaa5910efff944a
ref: Land2010longitudinalstudy
researcherid-numbers: Levy, Douglas/W-1516-2019
times-cited: '37'
title: A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments
  in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular
  Disease
type: Article
unique-id: WOS:000285499600002
usage-count-last-180-days: '0'
usage-count-since-2013: '7'
volume: '7'
web-of-science-categories: Medicine, General \& Internal
year: '2010'