Tobacco use is the most common cause of preventable disease, disability, and death in the United States. Every year, it’s responsible for and billions of dollars in health care spending and productivity losses resulting from smoking-related sickness and death. Medicaid enrollees are disproportionately affected because they’re nearly twice as likely to smoke tobacco.
Cessation Medications Can Save Lives, but Many Medicaid Enrollees Don’t Access Them
As of 2024, most state Medicaid programs covered at least one FDA-approved cessation medication and counseling service, but few covered all seven medications and counseling for all adults across both fee-for-service and managed care plans. Requirements like prior authorization, copayments, and treatment caps further limit enrollees’ access to these medications. Systems-level challenges, including a lack of integration of screening and treatment into routine care, low provider engagement, underinvestment in public health outreach, and low awareness of treatment coverage among patients and providers, compound these issues.
Helping more people obtain life-saving treatment starts with understanding treatment rates and how they vary by state, medication type, and Medicaid plan type, among other factors. Below, explore the latest data on Medicaid prescriptions for cessation medications—including nicotine replacement therapy (NRT), such as Nicorette, and non-nicotine medications, such as Chantix and Zyban—among adult Medicaid enrollees from 2019 through 2025. The data will be updated quarterly throughout the project's duration.
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Medicaid State Drug Utilization Data Analyses
- Medicaid Tobacco and Nicotine Cessation Treatment Rates Remained Low, 2019–24
- Treatment for Tobacco and Nicotine Use Disorder in Medicaid: Trends in Nicotine Replacement Therapy, 2019–23
- Treatment for Tobacco and Nicotine Use Disorder in Medicaid: Trends in Varenicline, Bupropion, and Nicotine Replacement Therapy for Cessation Treatment, 2019–2025
Survey Data Analyses
ABOUT THE DATA
This tool displays national- and state-level data on Medicaid-covered prescriptions to treat tobacco and nicotine dependence. The primary source is the Centers for Medicare & Medicaid Services (CMS) Medicaid State Drug Utilization Data (SDUD), covering 2019 through 2025 and updated quarterly for the duration of the project.
We include five forms of nicotine replacement therapy—gum, lozenge, patch, inhaler, and nasal spray—as well as two non-nicotine medications. The non-nicotine medications include varenicline (e.g., Chantix and generics) and estimated bupropion (e.g., Zyban and generics). Bupropion estimates are derived from Medicaid claims analyses that distinguish cessation-related bupropion prescriptions from bupropion prescriptions for other uses.
To account for data suppression in SDUD, we imputed quarterly prescription counts for state-drug-plan type combinations for years with at least one quarter of unsuppressed data. Prescription fill counts reflect outpatient Medicaid administrative data and are displayed as total counts, per enrollee, and per adult with daily tobacco or nicotine use. Daily use prevalence is estimated from the National Survey on Drug Use and Health 2021–22 and adjusted annually using national trends from the National Health Interview Survey 2019–23; 2024 and 2025 rates are held equal to the 2023 observed rate.
Adult Medicaid enrollment denominators are based on CMS performance indicator data. Estimates are disaggregated by state, year, medication type, brand/generic status, and Medicaid plan type (fee-for-service or managed care). See methods and written products for methodological details and limitations.
PROJECT CREDITS
This data tool was funded by Global Action to End Smoking, formerly known as Foundation for a Smoke-Free World. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of our experts.
RESEARCH Lisa Clemans-Cope and Maya Payton
DATA VISUALIZATION AND DEVELOPMENT Mitchell Thorson
EDITING Sarah LaCorte
WRITING Rachel Kenney
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