Why Does Health Insurance Not Pay for Chantix to Help People Stop Smoking?

Written by James Hirby and Fact Checked by The Law Dictionary Staff  

If you've shopped around for health insurance in recent years, you're probably aware that smokers must pay a significant premium for their policies. Smoking is one of the riskiest health-related behaviors in which adults can engage. Although some people can smoke for their entire lives without developing complications like cancer or emphysema, many more smokers contract smoking-related illnesses that eventually kill them. Since these individuals must consume far more healthcare services than members of the general population, insurance companies must pay far more to cover their inpatient, outpatient and procedural costs. In turn, these companies pass these costs along to policyholders who smoke.

If you're trying to quit smoking, you might be surprised to learn that your health insurance company doesn't cover the cost of some prescription "stop-smoking" aids. Among these, Chantix is covered especially infrequently. It might seem strange that your insurance company would refuse to cover the cost of a drug that could dramatically reduce your total lifetime healthcare costs. Unless you have a particularly generous insurance plan, you'll probably have to shoulder the full cost of this drug on your own. Unfortunately, there are several reasons for this arrangement.

First, your insurance company may determine that your smoking habit has already exposed you to an unacceptable amount of risk. Depending upon your age, it may judge that your chances of developing costly smoking-related illnesses are too high to warrant a serious attempt to stop smoking. In other words, you may already be a "lost cause." Your insurance company might already be resigned to paying for the medical treatment that you'll need in the future.

Alternatively, your insurance company might be unwilling to shoulder the relatively high cost of Chantix. Since this drug costs several times more than generic stop-smoking aids, your insurer may refuse to cover its costs. If you can, ask your doctor to switch your prescription to a generic aid or a lower-cost brand-name drug like Zyban.

Finally, your insurer might not be sold on the safety and efficacy of Chantix. Although many studies indicate that it effectively encourages long-time smokers to quit, it may not be more effective than certain other methods. In addition, it appears to have the potential to cause serious side effects. These include depression, suicidal thoughts, emotional swings, mania and other psychological problems. Your insurer might conclude that the potential cost of these side effects is simply too great to bear.

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