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The demand for behavioural counselling and/or cessation pharmacotherapy is directly related to the level of health insurance coverage, and inversely related to out-of-pocket costs.

Individuals who face no out-of-pocket costs for obtaining cessation pharmacotherapy are more likely to use it, and use it for longer periods of time than individuals who face out-of-pocket costs. After varenicline was made available on the Pharmaceutical Benefits Scheme in Australia in 2008, its reported use increased sharply. Making smokers aware of insurance coverage for pharmacotherapy and making it easy to obtain the medication, increases use of the medication and quit rates, even in the absence of insurance coverage for behavioral counseling. For example, insurance coverage of workplace-based cessation results in greater numbers of successful cessations and decreased rates of smoking-related diseases.

However, simply providing coverage for pharmacotherapy, without efforts to make smokers aware of the covered benefit, was not shown to increase the use of medication and quit rates. From 1999 to 2000, the UK made bupropion and NRT reimbursable and made NRT products available without prescription in general sales settings. This resulted in a large increase in sales of this pharmacotherapy and the proportion of smokers using it doubled from 8% to 9% in 1999 to 17% in 2002.
The implementation of a national reimbursement policy for smoking cessation, behavioral counseling, and behavioral counseling with pharmacotherapy in the Netherlands in 2011, accompanied by a media campaign promoting the benefit, significantly increased the use of pharmacological therapy, the number of quit attempts, and quit success.

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Reda AA, Kotz D, Evers SM, van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev. 2012; 6: CD004305.pub4.

Solberg LI. Impact of insurance coverage on the use and effects of smoking cessation medications. Dis Manage Health Outcomes. 2005; 3(13): 151-158.

Nagelhout GE, Willemsen MC, van den Putte B, de Vries H, Willems RA, Segaar D. Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: a real-world study in the Netherlands. Tob Control. 2015; 24: 455–461.

Cooper J, Borland R, Yong HH. Australian smokers increasingly use help to quit, but number of attempts remains stable: findings from the International Tobacco Control Study 2002-09. Au NZ J Public Health. 2011; 35: 368-376.

West R, DiMarino ME, Gitchell J, McNeill A. Impact of UK policy initiatives on use of medicines to aid smoking cessation. Tob Control. 2005; 14: 166-171. logo
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