Insurance Coverage and Utilization of Nicotine Patches after Receipt of a Prescription

Abstract

Introduction: Changes in reimbursement policy have made nicotine replacement therapy (NRT) much more available, but little is known about what happens to patients after they receive their prescription. This study describes rates of successfully filling prescriptions for NRT and its association with type of insurance. Methods: We identified 224 patients who received a prescription for NRT during an outpatient visit to an academic medical center between January 1st 2016 and February 10th 2017. We conducted telephone surveys to assess whether they tried to fill their prescriptions and if so, determine the effects of insurance type on the ability to successfully fill the prescription. Results: Of 117 patients completing the survey, 23 (19.6%) did not attempt to fill and 6 (5.1%) had no insurance. Of the 90 patients with insurance who attempted to fill their prescription, 67 (74.4%) were successful and 23 (25.6%) were unsuccessful in obtaining medications. Success varied by insurance with successful fills ranging from 34 (87.2%) of those with commercial insurance, 24 (70.6%) with Medicaid, to 9 (52.9%) with Medicare. Of 37 participants living with another smoker, 31 (83.7%) wanted an NRT prescription specifically for their partner; several volunteered that they had shared patches with their partner. Conclusions: Despite widespread coverage for NRT, many patients may still encounter difficulties in getting their prescriptions filled. Some tobacco users might also benefit from getting NRT prescriptions for their partners that smoke.

Commentary on Thomas et al.: Are simple solutions to complex problems possible?

“…The authors acknowledge the inability of their study design to attribute causality and the inability to adjust for potential time‐varying confounders. In addition, it cannot be assumed that the smoking cessation medication prescribed was actually picked up from a pharmacy and used by the consumer, given that past studies have found that 20% of people prescribed NRT do not try to fill it [7]. Other limitations to note include the potential for Type 1 error (given multiple tests of significance), and the large effect sizes and extremely wide confidence intervals observed for the analysis exploring the impact of varenicline prescribing on ‘suicide deaths’ (suggestive of a sparse data issue and thus probably a spurious finding).…”