Learning Objectives: Conceptualize a model that will allow them to estimate the costs and savings of a Medicaid and Medicare tobacco cessation benefit and to understand how such a benefit would virtually pay for itself over a ten-year budget window.
Abstract: Problem/Objective – While the evidence supporting the clinical effectiveness of tobacco cessation is overwhelming, many publicly funded health care programs, including Medicare and Medicaid, do not cover cessation. Among the most significant barriers facing advocates for cessation, has been the lack of any estimates of the costs of providing a cessation benefit. This session is directed toward advocates, lawmakers and others who are interested in learning about the costs of providing a Medicare and Medicaid cessation benefit.
Methods – The model that was developed to generate the cost estimates is based on a lengthy review of the literature on cessation coverage, costs and savings. This was then translated into a spreadsheet that modeled the costs of Medicare and Medicaid cessation legislation pending in Congress.
Results – The costs were highly dependent on several key assumptions, notably the rate of utilization of services, the rate of long-term abstinence achieved, and, in the case of Medicaid, the design of the formulary. Over a 10-year budget window, the savings, both within Medicare and Medicaid, and to other government programs, more than paid for the costs of the benefit.
Discussion – While these estimates are valuable and instructive of what a Medicare or Medicaid cessation benefit could cost, they are equally valuable in their ability to engage key decision makers in a dialogue about coverage, particularly when faced with massive budget deficits. Having cost estimates in-hand keeps the conversation going and allows more opportunities to educate key lawmakers and decision-makers about the value of providing cessation benefits.
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