Michigan Insurers’ Tobacco Cessation Benefits

As of 06/01/04

Pharmacy ( Members must have drug benefit)

Cessation Programs

 

Health Plan

 

Patch

 

Gum

 

Lozenge

 

Inhaler or Nasal Spray

 

Zyban

Pharmacy tied to program enrollment?

 

Group Classes

 

Telephone

Counseling

Blue Care Network

1-800-662-6667

OTC

Covered with RX and counseling

OTC

Covered with Rx and counseling

Not Covered

Rx 90 days per 12 mos

Rx

No

Community classes

Discounts available

100% covered

Members may self refer

Call 1-800-811-1764

Blue Cross Blue Shield of MI (Traditional)

Refer to # on card

OTC

Not Covered

Rx Covered

OTC

Not Covered

 

Not

Covered

Rx

Rx

No

Not Available

100% covered

Members may self refer

Call 1-800-811-1764

Blue Cross Blue Shield of MI (PPO)

Refer to # on card

OTC

Not Covered

Rx Covered

OTC

Not Covered

 

Not

Covered

Rx

Rx

No

Not Available

100% covered

Members may self refer

Call 1-800-811-1764

 

Botsford Health Plan

1-800-479-5122

Rx 90 days per cal yr

Rx 90 days per cal yr

Not

Covered

Rx 90 days

per cal yr

Rx 90 days per cal yr

No

100% covered if in network( reimbursed) referral required

Not Available

CAPE Health Plan

1-888-354-2273

Rx

OTC Covered with RX

Rx (PA)

OTC Covered with RX

Not Covered

Not Covered

Not Covered

No

100 % covered with PCP referral

Great Starts (Prenatal Smoking Cessation)

Members may self refer

Care Choices HMO

1-800-852-9780

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Not Covered

Nasal Spray only  Rx

Rx

Yes

Call 1-800-424-5252

100% covered

Members may self refer

Call 1-800-424-5252

Community Choice

1-800-390-7102

Rx (PA

OTC Covered with RX)

Rx (PA)

OTC Covered with RX

Not Covered

Rx(PA)

Rx (PA)

No

Not Available

Not Available

Great Lakes Health Plan

1-800-903-5253

Rx (PA)

OTC Covered with RX

Rx (PA)

OTC Covered with RX

Not Covered

Both covered by Rx (PA)

Rx (PA)

No

Not Available

Not Available

 

Health Alliance Plan

1-800-422-4641

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Both covered by Rx

Rx

No

100% covered

Members may self refer

100% covered

Members may self refer

Call 1-888-427-7587

Health Plan of MI

1-888-437-0606

Rx 90 days per cal yr

Not

Covered

Not

Covered

Not

Covered

Rx 90 days per cal yr

No

100% covered

Not Available

HealthPlus of MI

1-800-332-9161

C-Rx  Habitrol

MM-Rx Nicoderm CQ, OTC patch

Not Covered

Not Covered

C-Rx

MM-Not Covered

Rx

No

100% covered

100% covered

Call 1-888-297-0699

 

C- Commercial MM-Managed Medicaid

RX- Prescription required

PA- Preauthorization required, call health plan prior to writing prescription   

Benefits are subject to change at each insurer’s discretion. This information is updated quarterly, current as of 06/01/04. To print the most recent edition, go to

http://www.mahp.org/MAHP%20Foundation/smoking/benefitsgrid.htm

 

 

As of 06/01/04

Pharmacy (Members must have drug benefit)

Cessation Programs

 

Health Plan

 

Patch

 

Gum

 

Lozenge

 

Inhaler or Nasal Spray

 

Zyban

Pharmacy tied to program enrollment?

 

Group Classes

 

Telephone

Counseling

M-CARE

1-866-995-8671

 

C-Not Covered

 

MM-Rx

C-Not Covered

 

MM-Rx

 

C-Not Covered

MM-Rx

C-Rx

MM-Rx

C-Rx

MM-Rx

No

100% covered for approved classes

Members may self refer

Call 1-888-448-3865

100% covered

Members may self refer

Call 1-866-995-8671

McLaren Health Plan

1-888-327-0671

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Not Covered

Rx

Rx

No

Not Available

Not Available

Medicaid Fee for Service

Refer to # on card

Rx (PA)

Call 1-877-864-9014

Rx (PA)

Call 1-877-864-9014

Not Covered

Not Covered

Rx (PA)

Call 877-864-9014

No

Not Available

Not Available

Midwest Health Plan

1-888-654-2200

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Not Covered

Not Covered

Rx

No

Not Available

100% Covered

Members may self refer

Call 1-800-480-7848

Molina Health Care

1-888-898-7969

Rx

OTC Covered with Rx 3 mo supply

Rx (PA)

OTC Covered with RX

Not Covered

Rx for both (PA)

Rx (PA)

No

Not Available

Not Available

Physician’s Health Plan of Mid-MI

1-800-661-8299

50% Co pay

OTC covered with Rx

50% Co pay

OTC covered with Rx

50% Co pay

OTC covered with Rx

50% Co pay

(PA)

50% Co pay

(PA)

Yes

50 % Co pay

Not Available

Priority Health

1-800-942-0954

C-Rx

Generic only

MM-Rx Generic only

C-Not Covered

MM-Not Covered

Not Covered

C-Rx

MM-Rx

C-Rx

MM-Rx

No

Community classes available

100% covered

Members may self refer

Call 1-800-446-5674

Self Paced web based tobacco cessation

Program Myhealth go to:

www.priority-health.com/myhealth

Total Health Care

1-313-871-7873

Not Covered

Rx

OTC Covered with RX

Not

Covered

Not Covered

Rx (PA) Generic

No

Covered

Members may call

1- 313-871-7873

Covered

Members may call 1-313-871-7873

The Wellness Plan

1-800-875-9355

Rx

OTC Covered with RX

Rx

OTC Covered with RX

Not Covered

Rx

Rx

Yes

Covered

Members may call

1-866-223-0321

 100% covered

Members may contact TWP’s Smoking Resource Center @ 1-866-223-0321

Upper Peninsula Health Plan

1-800-835-2556

Rx

OTC Covered with Rx

 90 day supply per yr

Rx

OTC Covered with Rx

 30 day supply per yr

Not

Covered

Not Covered

Rx (PA)

 90 day supply per yr

No

Not Available

Members may call 1-800-480-7848

 

C- Commercial MM-Managed Medicaid

RX- Prescription required

PA- Preauthorization required, call health plan prior to writing prescription   

Benefits are subject to change at each insurer’s discretion. This information is updated quarterly, current as of 06/01/04. To print the most recent edition, go to

http://www.mahp.org/MAHP%20Foundation/sming/benefitsgrid.htm