Section 5164.10 | Coverage of tobacco cessation medications and services.

• Effective: September 18, 2020
• Latest Legislation: House Bill 11 - 133rd General Assembly

(A) The medicaid program shall cover both of the following, subject to division (C) of this section:

(1) All tobacco cessation medications approved by the United States food and drug administration;

(2) All forms of tobacco cessation services recommended by the United States preventive services task force, including individual, group, and telephone counseling and any combination thereof.

(B) The department of medicaid shall not impose any of the following conditions with respect to the coverage required by this section:

(1) Counseling requirements for tobacco cessation medications;

(2) Except as provided in division (B)(4) of this section, limits on the duration of services, including annual or lifetime limits on the number of covered attempts to quit using tobacco;

(3) Cost-sharing requirements under section 5162.20 of the Revised Code;

(4) Prior authorization requirements, step therapy protocols as defined in section 5164.7512 of the Revised Code, or any other utilization management requirements, except that prior authorization may be required for either of the following:

(a) Treatment that exceeds the duration recommended in the United States public health service clinical practice guidelines on treating tobacco use and dependence;

(b) Services associated with more than two attempts to quit using tobacco within a twelve-month period.

(C) The director of health shall adopt rules in accordance with Chapter 119. of the Revised Code that establish standards and procedures for approving the forms of tobacco cessation medications and services that must be covered under this section. The rules shall also establish standards and procedures for updating the approved forms of tobacco cessation medications and services that must be covered under this section when the approved forms are modified by the United States food and drug administration, United States public health service, or United States preventive services task force.

(D) With respect to the coverage required by this section, the department of medicaid shall do both of the following:

(1) Inform medicaid recipients about the coverage;

(2) Market the coverage to Medicaid recipients.

Available Versions of this Section

• September 29, 2017 – Enacted by House Bill 49 - 132nd General Assembly
• September 18, 2020 – House Bill 11 - 133rd General Assembly