Below are answers to health professionals' frequently asked questions about smoking and tobacco use cessation.
- What is 1-800-QUIT-NOW?
- Can we make our VA Medical Center smoke-free with no smoking on the grounds?
- What is the national policy with regard to pharmacy restrictions that require Veteran patients to attend smoking cessation clinic before receiving smoking cessation medications?
- What does the elimination of co-payment for the outpatient smoking cessation counseling mean for Veterans in care in VA?
- Why was the co-payment for smoking cessation counseling eliminated?
- When was the co-payment eliminated?
- Does the elimination of the co-payment for smoking cessation counseling also apply to smoking cessation medications such as nicotine replacement therapy (NRT) and bupropion?
- Does the elimination of the co-payment for smoking cessation counseling apply to only primary care settings in VA? What are the proper stop codes?
- How can I get additional information?
1-800-QUIT-NOW (or 1-800-784-8669) is the number that acts as a national portal to connect any smoker who is seeking assistance in quitting to the appropriate state telephone counseling quitline for free telephone counseling. This is a national initiative that is supported by the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Quitline Consortium. Telephone counseling quitlines are an evidence-based smoking cessation intervention that may be especially helpful to Veteran patients who may be unwilling or unable to attend smoking cessation counseling because of their work, their disabilities, or because they would have to travel significant distances to their nearest VA. A referral or recommendation to a telephone counseling quitline should be coordinated by a VA provider with a prescription for nicotine replacement therapy or other medications. Referrals to 1-800-QUIT-NOW should also be documented in the patient’s medical record as part of brief counseling.
For additional information, please refer to:
Currently, there is still a Federal Law in place requiring that VA medical centers (VAMCs) provide outdoor areas for Veteran patients to smoke. This was a law proposed and enacted by Congress in the early 1990’s when the Veterans Health Administration (VHA) was moving to make all facilities smoke-free. Until Congress provides legislative authority for VAMCs to become smoke-free, VA medical centers cannot become completely smoke-free.
However, there is much that facilities can do to decrease exposure to secondhand smoke, such as decreasing the number of outdoor smoking shelters and making them less visible. Some facilities have been successful in reducing all but one outdoor shelter for Veteran patients and one for employees, as providing an area for employees has been part of collective bargaining agreements in some cases.
It is important that smoking shelters be placed far away from the entrances to VA health care facilities for a number of reasons, including safety. Given that there is increasing evidence that the ventilation systems included in indoor smoking areas on inpatient psychiatric or long-term care do not effectively remove hazardous exposures associated with secondhand smoke (see the 2006 Surgeon General Report), the use of these areas will be phased out and inpatients should be provided with nicotine replacement instead to prevent nicotine withdrawal.
3. What is the national policy with regard to pharmacy restrictions that require Veteran patients to attend smoking cessation clinic before receiving smoking cessation medications?
There is no national policy requiring that Veteran patients attend smoking cessation clinic before they can receive a prescription for nicotine therapy replacement (NRT) or bupropion. Previously, such a restriction was part of national policy, but this restriction was lifted in VHA Directive 2003-042 as it was inconsistent with the previous VA/DoD Clinical Practice Guidelines (as well as the 2004 Guidelines), and it was a policy that was not supported by the research evidence.
Given that smoking is still the leading cause of preventable death and disease, it is important to remove any potential barriers to effective smoking cessation treatment. As smoking cessation medications, such as NRT, are an important part of evidence-based treatment, Veterans who want to quit using tobacco should have access to NRT. There is also no evidence to support the practice of limiting a patient to only one trial of NRT over the course of a year. Smoking is a chronic relapsing disorder and even the most motivated Veterans may attempt to quit 5 to 6 times before they are successful. For additional information about how to prescribe smoking cessation medications, please see VA Formulary Choices for Pharmacotherapy of Smoking Cessation (103 KB, PDF)
4. What does the elimination of co-payment for the outpatient smoking cessation counseling mean for Veterans in care in VA?
The elimination of the co-payment for outpatient smoking cessation counseling (individual or group) removes any concerns about the co-payment as a potential barrier for any Veteran who smokes who wants to quit. There is strong scientific evidence that smoking cessation counseling helps people quit smoking and that providing no-cost counseling increases its use fourfold and that those counseled are four times more likely to quit. Such counseling can range from brief individual sessions with a primary care physician to multiple group counseling sessions in a specialty clinic.
Veterans receiving care in VA are disproportionately affected by smoking-related illnesses. Smoking cessation is one of the most cost-effective prevention interventions, second only to childhood immunizations. Despite its effectiveness, counseling for smoking cessation is widely underutilized in the VA health care systems and other systems nationally. As smoking and tobacco use cessation is a public health priority for the Veterans Health Administration, the co-payment has been eliminated to decrease any potential barriers to counseling and increase access to care for Veterans who want to quit using tobacco.
Effective May 2, 2005, the co-payment for outpatient smoking cessation counseling (individual or group) was eliminated through the publication of an Interim Final Rule that changed the regulation governing VHA outpatient co-payments. On June 23, the VHA Business Office released a patch to the field implementing this change, and the co-pay became $0 instead of the basic co-payment that was previously charged of Priority Category 7 & 8 Veterans. The elimination of the outpatient co-payment was retroactive to May 2, 2005. VA reimbursed all Category 7 & 8 Veterans who had been assessed and paid a co-payment for smoking cessation counseling on or after May 2, 2005.
7. Does the elimination of the co-payment for smoking cessation counseling also apply to smoking cessation medications such as nicotine replacement therapy (NRT) and bupropion?
No, there will still be a pharmacy co-payment for any Veteran who typically has a medication co-payment. The elimination of the co-pay applies only to smoking cessation counseling only.
8. Does the elimination of the co-payment for smoking cessation counseling apply to only primary care settings in VA?
No, the elimination of the co-payment for either individual or group smoking cessation counseling is applicable to any outpatient setting in VA. However, in order to ensure that a co-payment for outpatient smoking cessation counseling is not assessed, the following stop codes must be used:
- 533707 Smoking Cessation Counseling – Individual
- 566707 Smoking Cessation Counseling - Group
If other stop codes are used, the patient may be charged a co-payment.
If you have questions about the elimination of the smoking cessation counseling co-pay or smoking or tobacco use cessation, please email the Clinical Public Health group at firstname.lastname@example.org.
Note: E-mails sent to this address are not secure. Please do not include personal data. To send a secure e-mail, use VA's Ask a Question - IRIS (a secure website contracted to VA). Scroll down to the middle of the right-hand side of the page to find "Ask a Question."
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