Access to effective cessation treatment, such as nicotine patches, gum, and lozenges, can help reduce tobacco and nicotine dependence and improve health outcomes. Between 2019 and 2023, although Medicaid enrollment and overall prescriptions of nicotine replacement therapy (NRT) increased, per-person prescription rates decreased. Coverage gaps and restrictions such as prior authorization and limits on treatment duration restrict access to these critical medications.

Why This Matters

Medicaid enrollees use tobacco and nicotine at higher rates than other insured groups, increasing their risk of chronic illness and health care costs. Improving Medicaid coverage and reducing access barriers for NRT—including by eliminating prior authorization, expanding reimbursement to more provider types, and integrating treatment into primary and behavioral health care—could improve health outcomes and decrease health care costs. But uncertainty around federal funding, from proposed Medicaid budget cuts to the potential expiration of CDC funding for cessation programs such as state quitlines, poses significant risks to the maintenance and expansion of cessation treatment for Medicaid enrollees.

Key Findings

• Total Medicaid NRT prescriptions increased by 15 percent, from 1.5 million in 2019 to 1.7 million in 2023. Adult Medicaid enrollment increased by 43 percent, however, causing per capita prescription rates to decrease.
• Prescription patterns changed between 2019 and 2023: nicotine patches remained the most common, but gum and lozenges increased as a share of NRT prescriptions.
• In 2023, NRT prescription rates differed by Medicaid expansion status. States that expanded Medicaid before 2019 had the highest prescription rates (186 fills per 1,000 adult enrollees with daily tobacco or nicotine use). Recent expansion states (those that expanded Medicaid after 2019) had lower rates (167 fills), and non-expansion states had the lowest (66 fills).
• In 2023, all but two states covered gum, patches, and lozenges for traditional Medicaid enrollees. Access barriers were common, however, as nearly half of states imposed duration or annual limits on NRT and more than one-third required prior authorization.

How We Did It

We analyzed Medicaid State Drug Utilization Data from 2019 to 2023 and combined this analysis with state-level estimates of adult Medicaid enrollment and daily tobacco or nicotine use derived from the National Survey on Drug Use and Health. We obtained Medicaid cessation coverage policies from the American Lung Association’s State Tobacco Cessation Coverage Database. We categorized and compared states by their Medicaid expansion status.

Portions of this report were developed with the assistance of generative AI. Please see the Urban Institute’s generative AI policy.