Vidyya Medical News Service
Volume 6 Issue 361 Published - 14:00 UTC 08:00 EST 26-Dec-2004 Next Update - 14:00 UTC 08:00 EST 27-Dec-2004
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Medicare will help beneficiaries quit smoking
New proposed coverage for counseling as Medicare shifts focus to prevention

HHS Secretary Tommy G. Thompson announced that the Centers for Medicare & Medicaid Services (CMS) intends to provide new coverage allowing certain Medicare beneficiaries who smoke to receive counseling services that will help them quit the habit.

"We're building on our efforts to help America's seniors help themselves to quit smoking and live longer," Secretary Thompson said. "This new benefit, focused on treating seniors' smoking related diseases, will go a long way toward reducing their risk of dying prematurely. The combination of lives lost, unnecessarily, and the cost of treating smoking-related diseases makes our investment in smoking cessation benefits all that more important. It's never too late to benefit from quitting smoking."

An estimated 9.3 percent of those age 65 and older smoke cigarettes. About 440,000 people die annually from smoking related disease, with 300,000 of those deaths in those 65 and older.

The Centers for Disease Control and Prevention (CDC) estimated in 2002 that 57 percent of smokers age 65 and over reported a desire to quit. Currently, about 10 percent of elderly smokers quit each year, with 1 percent relapsing.

"The evidence available fully supports the hope that seniors at risk of the diseases caused by smoking can quit, given the right assistance," CMS Administrator Mark McClellan, M.D., Ph.D. said. "As we add the 'Welcome to Medicare' exam and other preventive benefits and drug coverage, this is another step in using the medical evidence to turn Medicare into a prevention- oriented program."

The proposal to cover smoking cessation counseling comes in response to a June 2004 request from the Partnership for Prevention (PFP). The PFP requested CMS open a national coverage decision to consider coverage of tobacco cessation counseling as detailed in the HHS Public Health Service (PHS) 2000 Clinical Practice Guideline, Treating Tobacco Use and Dependence.

The guideline has been endorsed by many health care and professional organizations. Based on the evidence reflected in the guideline, CMS proposes to extend smoking cessation coverage to beneficiaries who smoke and have been diagnosed with a smoking related disease or are taking certain drugs whose metabolism is affected by tobacco use. This announcement builds on a series of HHS initiatives designed to help Americans quit smoking, including the opening of a new national quitline (1-800-QUITNOW) and designating all HHS campuses tobacco-free.

While many may think those who quit smoking at age 65 or older fail to reap the health benefits of abstinence from tobacco, the U.S. Surgeon General has reported that the benefits of cessation do extend to quitting at older ages. Smoking cessation in older adults leads to significant risk reduction and other health benefits, even in those who have smoked for years.

The coverage decision involves Medicare beneficiaries who have an illness caused or complicated by smoking, including heart disease, cerebrovascular disease, lung disease, weak bones, blood clots, and cataracts -- the diseases that account for the bulk of Medicare spending today. It also applies to beneficiaries who take any of the many medications whose effectiveness is complicated by smoking -- including insulins and medicines for high blood pressure, seizures, blood clots and depression.

"The best way to prevent the serious health problems caused by tobacco is never to start using it. Millions of our beneficiaries have smoked for many years, and are now experiencing the heart problems, lung problems, and many other often-fatal diseases that smoking can cause. It's really hard to quit, but we are going to do everything we can to help," said Dr. McClellan. "I especially want to urge smokers on Medicare who are just starting to experience heart problems or lung problems or high blood pressure to take advantage of this new help -- and more is coming."

Medicare's upcoming prescription drug benefit will cover smoking cessation treatments that are prescribed by a physician.

CMS Chief Medical Officer Sean Tunis, M.D., said, "Federal policy has acknowledged tobacco as the number one cause of preventable death for decades now, and CMS has taken the lead in implementing coverage policy for our seniors to deal directly with this critical health problem."

In 1993, smoking cost the Medicare program about $14.2 billion, or approximately 10 percent of Medicare's total budget. On average, nonsmokers survived 1.6 - 3.9 years longer than those who have never smoked.

The proposed new coverage policy is available for review at the CMS coverage Web site ( The posting of this proposed coverage policy marks the beginning of a 30-day public comment period. After close of the comment period, CMS will have 60 days to review the comments and issue a final policy.

Source: Centers for Medicare & Medicaid Services

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