“This is an undeniably important first step to encouraging more smokers to seek treatment for the most difficult of all addictions to overcome,” Carol Southard, ADHA’s Smoking Cessation Initiative Manager, says. In her 20 years of specializing in smoking cessation programs, Southard says she has counseled many clients over the age 65—many of whom paid for cessation counseling out of pocket and suffered a smoking-related illness. “Without exception,” she says, “all who were able to quit realized quality-of-life enhancement.”

Smoking-related illnesses such as heart disease, cerebrovascular disease, lung disease, weak bones, blood clots, and cataracts, account for the bulk of Medicare spending today. The new coverage policy also applies to beneficiaries who take any of the many medications whose effectiveness is complicated by tobacco use – including insulins and medicines for high blood pressure, blood clots, and depression. Medicare’s upcoming prescription drug benefit will also cover smoking cessation treatments that are prescribed by a physician.

The Centers for Disease Control and Prevention (CDC) has estimated that 9.3 percent of Americans 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. CDC estimated in 2002 that 57 percent of smokers age 65 and over report a desire to quit. Currently, about 10 percent of elderly smokers quit each year, with 1 percent relapsing.

“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,” CMS Chief Medical Officer Sean Tunis said in a press release.

The benefits of cessation do extend to quitting at older ages, according to the U.S. Surgeon General. Smoking cessation in older adults leads to significant risk reduction and other health benefits, even in those who have smoked for years. “The evidence fully supports the hope that seniors with diseases and health effects caused by smoking and tobacco use can quit, given the right assistance,” CMS Administrator Mark B. McClellan said in the press release.

Researchers estimate that smoking accounts for approximately 10% of the total costs of the Medicare program, or about $20.5 billion in 1997. On average, nonsmokers survived 1.6 to 3.9 years longer than those who have never smoked. “Covering smoking and tobacco use cessation counseling for seniors has great potential to save and improve lives for millions of seniors,” McClellan said. “This is another step in turning Medicare into a prevention-oriented health program.”

While Southard applauds the CMS decision to cover cessation intervention, she says, “I am an advocate of cessation coverage for all tobacco users. Billions of dollars would be saved in this country, not to mention immense improvement in quality of life, if smokers quit prior to developing a smoking-related illness.”

The decision to cover cessation counseling came in response to a June 2004 request from the Partnership for Prevention (PFP). The PFP requested that CMS consider coverage of tobacco cessation counseling as detailed in the U.S. Department of Health and Human Services, Public Health Service (PHS) 2000 Clinical Practice Guideline: Treating Tobacco Use and Dependence.

In response to criticism, CMS modified its proposal by removing a requirement that providers have uniform training in smoking and tobacco use cessation counseling, since no nationally accepted standards exist. When standards do become available, CMS plans to consider whether to add those requirements to its coverage policy.

“Millions of Medicare beneficiaries have smoked for many years, and are now experiencing the heart problems, respiratory problems, and many other often-fatal diseases that smoking can cause,” McClellan said. “It’s really hard to quit, but we are going to do everything we can to help.”

-Kristen Romanowski