Bill rejected on smoking cessation

The Arkansas House on Monday voted down a measure that would increase the products available to smokers trying to quit.

House Bill 1555 by Rep. Andrew Collins, D-Little Rock, would make all seven tobacco-cessation products approved by the U.S. Food and Drug Administration available to Arkansas Medicaid recipients without prior authorization.

Currently, Arkansas’ Medicaid program allows access to four of the products without prior authorization, but Collins’ measure would extend similar coverage to nicotine replacement therapy lozenges, nasal spray and inhalers.

The legislation failed in a 48-24 vote after several members questioned Collins about the cost and effectiveness of nicotine replacement therapy. The measure needed 51 votes for approval.

Collins said that lozenges cost $259 a month; the nasal spray is $317 a month; and the inhalers are $1,200 a month. He noted that the Bureau of Legislative Research alluded to research in its fiscal impact report that indicates that every dollar spent on tobacco cessation medications results in 3-to-1 savings on tobacco-related illness-treatment costs.

Rep. Dan Sullivan, R-Jonesboro, said that the Legislature has enacted a variety of measures over the years to try to curb tobacco use in Arkansas, but that the state’s tobacco use remains among the highest in the U.S.

“Can you give me some assurance that this will be the silver bullet that makes people stop smoking in Arkansas?” Sullivan asked.

“I wish it was a silver bullet,” Collins replied. “I’m sure it’s not the silver bullet, but what it is is another thing we can do to increase the use of these medications.”

Arkansas has the third-highest rates in the nation of adult tobacco use and new lung cancer diagnoses. He added that tobacco use is estimated to cost the Arkansas Medicaid program about $795 million annually.

“Each of the three therapies has proven effectiveness,” Collins said. “It basically doubles the rate of long-term abstention from tobacco. The [U.S. Centers for Disease Control and Prevention] finds that more choices increases the likelihood of finding a drug and an approach that meets the patient’s needs.”

Collins also said that 23 other states have passed legislation similar to HB1555.

Prior authorization requires the doctor or patient to contact the Medicaid program to authorize a medication before it’s prescribed. This puts up a barrier that can delay treatment and discourage use, according to the American Lung Association.

Some states also use the prior authorization mandates to steer patients toward cheaper treatment options, according to the American Lung Association.