Tobacco and nicotine use is the leading cause of preventable death in the United States, and its burden falls hardest on the roughly 43 million adults covered by Medicaid, who use tobacco at more than twice the rate of adults with private insurance. Medicaid covers proven medications that help people quit, but few enrollees who need them actually receive them. This report tracks Medicaid-covered cessation prescriptions from 2019 to 2025, showing how treatment reach and the mix of medications across states have changed. Readers can explore state-level prescribing and treatment rates in the accompanying interactive dashboard.

Why This Matters

Cessation medications are among the most cost-effective treatments in health care, and helping enrollees quit decreases the substantial tobacco-related costs Medicaid already bears. Even so, most enrollees who want to quit never get evidence-based help. Federal funding for tobacco control has been reduced, and Medicaid now faces reductions under the One Big Beautiful Bill Act. As budgets tighten, states will have to make difficult choices. State policymakers, Medicaid programs, and public health agencies can use these findings to strengthen cessation coverage and target it toward the states and enrollees with the lowest treatment rates.

What We Found

From 2019 to 2025, Medicaid-covered cessation treatment remained limited and uneven across states:

• Treatment rates stayed very low, with only about 1 in 9 enrollees who likely needed treatment for tobacco or nicotine use receiving it. The estimated share of adults with daily tobacco or nicotine use who received cessation medication was 11.4 percent in 2019 and 11.5 percent in 2025, dipping somewhat in the intervening years.
• Total treatment prescriptions increased slightly, and the mix shifted sharply toward nicotine replacement therapy. Total fills rose 9.1 percent, from 2.8 million to 3.1 million. Over the same period, varenicline fills fell 35 percent, while nicotine replacement therapy fills rose 28.8 percent and grew to nearly two-thirds of all cessation fills.
• Treatment varied enormously across states. In 2025, fills per 1,000 enrollees who use tobacco or nicotine daily ranged from 909 in Utah to 38 in Alabama, a more than twentyfold gap between the highest and lowest states.
• States that expanded Medicaid earlier reached far more people who needed treatment. Early-expansion states had an estimated treatment rate of 13.2 percent in 2025, compared with 5.6 percent in nonexpansion states, even though nonexpansion states had higher rates of tobacco use.

How We Did It

We tracked Medicaid-covered cessation prescriptions from 2019 to 2025 using the Centers for Medicare & Medicaid Services’ State Drug Utilization Data, which records the outpatient drugs Medicaid paid for in every state. We used Medicaid claims data to estimate how many bupropion prescriptions were for cessation rather than depression and the typical number of fills per treated person. To estimate how many enrollees use tobacco or nicotine daily, we combined national survey data with Medicaid enrollment counts. The analysis is descriptive.

This report was funded by Global Action to End Smoking, formerly known as Foundation for a Smoke-Free World.