Clarifying Tobacco Cessation Copay.pdf

ForwardHealth covers tobacco cessation counseling and pharmacotherapy services, including legend drugs and over-the-counter (OTC) products, with a written prescription from a prescriber. Prior authorization (PA) is not required for tobacco cessation counseling services or tobacco cessation products within approved diagnoses. BadgerCare Plus and Medicaid do not require a copayment for tobacco cessation services. The U.S. Preventive Services Task Force recommends that providers ask all adults about tobacco use, advise them to stop using tobacco, and provide tobacco cessation counseling services. Providers may refer to the Legend Drugs topic in the Covered Services and Requirements chapter of the Covered and Noncovered Services section of the Pharmacy service area for more information about legend drugs. A written prescription from a Medicaid-enrolled prescriber is required for legend and OTC tobacco cessation products. Tobacco cessation services, as preventive services with an A or B rating from the USPSTF, do not require copayments from any member enrolled in BadgerCare Plus or Medicaid. SeniorCare members are not exempt from copayment for tobacco cessation services. For more information about copayment exemptions, providers may refer to the Exemptions topic in the Copayment chapter of the Reimbursement section of the Online Handbook.