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