Post date: March 30, 2018

In the Pharmacy: Pharmacists Furnishing Nicotine Replacement Products

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Learning Objectives:

  • Review the California State Board of Pharmacy regulations for pharmacists to furnish nicotine replacement therapy (NRT) products, which have been in effect since January 2016.
  • Describe strategies to promote smoking cessation in pharmacy practice.
  • Summarize best practices for responsible prescribing of NRT products.

Key Points:

  • Tobacco dependence continues to be a leading cause of preventable morbidity and mortality, and often requires repeated interventions and multiple quit attempts.
  • Medicaid enrollees have a high and relatively unchanging smoking prevalence, in comparison to the non-Medicaid population.
  • NRT, including combinations of NRT formulations (for example, patch plus a short-acting NRT as needed), is a recommended first line treatment. Currently, nicotine gum, lozenge, and patch are on the Medi-Cal fee-for-service Contract Drugs List.
  • Managed Care Plans (MCPs) are contractually required to cover all FDA-approved tobacco cessation medications for adults who use tobacco products. At least one FDA-approved tobacco cessation medication must be available without authorization.
  • Effective January 25, 2016, pursuant to Section 1746.2 of the California Code of Regulations, pharmacists are authorized to furnish nicotine replacement products approved by the U.S. Food and Drug Administration (FDA) for use by prescription in accordance with a protocol approved by the California State Board of Pharmacy and the Medical Board of California.
  • While the regulation allowing pharmacists in California to furnish NRT became effective over two years ago, claims data for the Medi-Cal fee-for-service program shows limited adoption among California pharmacists.
  • Recent legislation allows pharmacist reimbursement for specified pharmacy services, including furnishing of NRT products. For claims to be reimbursed, the furnishing pharmacist must complete the Medi-Cal Ordering/Referring/Prescribing Provider

Application/Agreement/Disclosure Statement For Physician and Non-physician

Practitioners (DHCS 6219) application form and be enrolled as an ordering, referring, and prescribing (ORP) provider. DHCS 6219 application forms are available on the Medi-Cal website.

Background

Tobacco dependence continues to be a leading cause of preventable morbidity and mortality.

Each year, smoking kills approximately 480,000 Americans and costs the nation more than $300 billion a year, including nearly $170 billion in direct medical care for adults and $156 billion in lost productivity.1,2 Notably, Medicaid enrollees have a high and relatively unchanging smoking prevalence compared to the general population, and smoking-related disease is thus a major contributor to increasing Medicaid costs.3,4 According to California Health Interview Survey data available through the UCLA Center for Health Policy Research, the estimated smoking prevalence among adult Medi-Cal beneficiaries in 2016 was 16.0% (versus 11.2% statewide).5

Tobacco use and exposure to secondhand smoke are known causes of cardiovascular disease, respiratory disease, multiple cancers, reproductive complications, and many other diseases.1 A majority of tobacco users are aware of these health consequences and are interested in quitting. In fact, 68% of current smokers in the United States report they want to quit completely; however, less than 10% succeed on their first attempt.6 Tobacco dependence is a chronic disease that often requires repeated interventions and multiple quit attempts.7 Clinicians and health care systems can play a major role in helping patients develop an effective smoking cessation plan.

Current clinical guidelines emphasize the importance of both counseling and medication in assisting tobacco users with cessation efforts.7 They also encourage health systems, insurers, and purchasers to make the following effective treatments available: individual, group, and telephone counseling and seven medications approved by the FDA (bupropion sustained-release, varenicline, and five NRT formulations: patch, gum, inhaler, nasal spray, and lozenge).7 The

2001 − 2010 National Health Interview Survey noted that only 31.7% of patients had used counseling and/or medications when they tried to quit.6

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