This evaluation project measured the impact of the introduction of a new smoking cessation pharmacotherapy benefit between two groups of smokers in two large health plans. Because some purchasers elected to provide the new benefit and some did not, there was a real-world opportunity to evaluate the impact of the benefit. The study also tested the impact of the new benefit on provider behavior with patients who smoke.

Comparisons in knowledge of the benefit, utilization of bupropion or Zyban, quit attempts, and sustained cessation were made between smokers whose insurance included the new benefit and smokers whose insurance did not include the new benefit. To identify smokers, a double-reply postcard was sent to 163,596 health plan members covered by the identified groups. From an initial sample of 3,703 respondents, 3,200 completed baseline surveys. Three hundred two were excluded from the 12-month follow-up (n=2,898). The final sample across both time points was 2,327 smokers.

At 1-year follow-up, smokers with the benefit were significantly more likely to know that medicines for smoking cessation were covered by their health plan (6% vs 30%, p < 0.0001), compared to the control group without the pharmacy benefit. Smokers with the benefit were no more likely to report use of bupropion or nicotine products in the previous year. Knowledge of the benefit did affect use and quit attempts but not quitting within those covered by the benefit.

Smokers were also surveyed about their interactions with their physician in the last year. Increases were noted in reports of assessment (4.9% increase, p=.01), assisted in setting a quit date (6.5% increase, p=.0004), encouraged to use medications (8.8% increase, p=.03), and given a prescription (8.6% increase, p=.0005). These increases were limited to smokers reporting awareness of the pharmacy benefit, asking for help in quitting, or both. Smoking cessation interventions during physician visits were associated with increased patient satisfaction with their health care, regardless of the patient's readiness to quit smoking.

The study found less than expected knowledge of and use of a new pharmacotherapy benefit for smoking cessation. Further research is needed to evaluate whether increased efforts to heighten patient awareness of benefits, or adding other types of cessation support, would increase the utilization of such a benefit and subsequent quit rates.