1. Margaret Reid, RN
Director, Healthy Homes & Community Supports
Boston Public Health Commission
11/13/2012

2.  Reasons to invest in tobacco policies
and benefits
 Influence of tobacco-free policies
 Importance of tobacco cessation
benefits
 Case study in Boston
 Questions

4. Nonsmokers Former Current
Smokers Smokers
Mean days missed 4.4 days 4.9 days 6.7 days
for work d/t health
conditions/year
Mean hours lost d/t 35.2hours 39.2 53.6
absenteeism/year hours hours
Mean hours lost d/t 42.8 hours 56.0 76.5
presenteeism/year hours hours
Journal of Occupational and Environmental Health, Volume 48, Number 10, October 2006.

5.  Implement policies that discourage
tobacco use
◦ Increase taxes on tobacco and packaging
◦ Create smoke-free public places
 Provide support for smokers who want to
quit
◦ Offer high-quality cessation benefits
 Prevent youth tobacco use
◦ Disrupt tobacco marketing to youth

6. August
2003: 2011:
September
Smoke Smoke 2012: Smoke
Free Free Tot Free Boston
Workplace Lots Public Schools
Law Passed Designated Policy in Effect
2008: April 2012: October 2012:
Smoke Smoke Smoke Free
Free Free Public
Workplace Hospital Housing Policy
Law Campuses in Effect
Updated

8.  Smoke free policies are effective because
◦ They make smoking inconvenient;
◦ They change the norm around what is acceptable
behavior;
◦ They convey the importance of protecting others
from secondhand smoke.
 SF policies result in less secondhand smoke
exposure and increase the likelihood that
smokers quit.

9.  Policy change alone is not
sufficient to achieve the goal
of reducing tobacco use.
 A robust, barrier-free
cessation benefit is a proven
way to help people quit
◦ Education and outreach to
promote benefit is important

10.  Cessation benefits work best when they:
◦ Cover the cost of counseling, including
telephone, individual and/or group counseling
◦ Offer counseling sessions over a period of several
weeks and have high or no limit on sessions
◦ Cover all FDA-approved cessation aids, including
prescription and over-the-counter drugs
◦ Limit out-of-pocket expenses for those making a
quit-attempt
◦ Do not require preauthorization

11. Prescription Medications Nicotine Replacement
Therapy (OTC)
Zyban (bupropion Nicorette (Gum)
hydrochloride)
Chantix (varenicline) Nicoderm CQ, Nicotrol (Patch)
Nicotrol NS (Spray)
Nicotrol Inhaler (Inhaler)

12. Insurance Plan Cessation Counseling Benefit Cessation Pharmacy Benefit
Gold Standard Offers bi-lingual telephone Covers NRT and prescription
counseling medications;
Will reimburse for 16 counseling $1-3 co-pay
sessions every 12 months, PA for
counseling beyond this limit
Major Insurer #1 Promotes Smokers Help Line and No coverage for NRT;
online support. $10 co-pay for generic drugs,
Offers reduced rate for QuitSmart $25 co-pay Chantix and
program Wellbutrin
Major Insurer #2 Promotes Smokers Help Line and Covers NRT and prescription
online support. medications;
$10 co-pay for generics ; $25
for Chantix and Wellbutrin

13.  The City of Boston has about 18,000 employees,
including the schools, public health, fire, police
and other municipal departments
 Employee benefits are negotiated between the
Public Employee Committee and city
management
 The city is self-insured
 Boston currently contracts with Neighborhood
Health Plan, Blue Cross/Blue Shield, Harvard
Pilgrim, and BMC HealthNet to offer insurance.

14. Unidentified
1%
Women
35%
Men
64%

15. 70+ yrs Under 20 yrs
60-69 yrs 6% 0%
12%
20-29 yrs
10%
30-39 yrs
19%
50-59 yrs
27%
40-49 yrs
26%

16. American Not Indicated
Indian Asian 10%
0% 3%
Hispanic
8%
White
Black
57%
22%

18. Adult Current Smoking, 2010

19.  The City was in a contract negotiation
year.
 Management understood the ROI on
offering a cessation benefit.
 Outside forces – municipal health
reform, interest in cost containment –
contributed to readiness on both sides to
negotiate.

20.  Public Employee Committee and
Management agreed to look at a 4-year
health benefit design, with a focus on
reducing costs
 Reducing costs = improving preventive
care and increasing wellness benefits and
chronic disease management
 Improved cessation aligned with these
goals.

21.  Once PEC and Management agreed on
cessation benefit, negotiations began with
Insurer
 For Insurer, big hurdle was whether they
would have to file with the Division of
Insurance to offer the change in benefit
 Since Boston was self-insured, the insurer did
not have to file, so the change was easier to
make.

22. Major Insurer #1 Before After
Cessation Reduced rate for Added on-site cessation
Counseling QuitSmart program. groups.
Benefit Continues to promote
Smokers Help Line and
online support and
reduced rate for QuitSmart
program
Cessation No coverage for NRT; Added coverage for NRT,
Pharmacy Benefit $10 co-pay for most at Tier 1 co-pay level
of $10.
generic drugs, $25
Continues coverage for
co-pay Chantix and
prescription medications
Wellbutrin

23.  Outreach: Outreach to employees so they are
aware of the new benefit and know how to
utilize
◦ Postcards to homes, city intranet sites
◦ Department Human Resource Directors educated
◦ Letter from Mayor Menino to every employee
◦ Promotion for Great American Smoke Out

24.  Evaluation: Will be asking the insurer for
data to assess uptake of the benefit by
employees.
◦ Monitor adoption among other large Boston
employers
◦ Continue to monitor smoking rates among
residents of Boston