Use of pharmacotherapies for smoking cessation: Analysis of pregnant and postpartum medicaid enrollees

Background The Affordable Care Act requires state Medicaid programs to cover pharmacotherapies for smoking cessation without cost sharing for pregnant women. Little is known about use of these pharmacotherapies among Medicaid-enrolled women. Purpose To describe the prevalence of prescription fills for smoking-cessation pharmacotherapies during pregnancy and postpartum among Medicaid-enrolled women and to examine whether certain pregnancy complications or copayments are associated with prescription fills. Methods Insurance claims data for women enrolled in a Medicaid managed care plan in Maryland and who used tobacco during pregnancy from 2003 to 2010 were obtained (N=4,709) and analyzed in 2014. Descriptive statistics were used to calculate the prevalence of smoking-cessation pharmacotherapy use during pregnancy and postpartum. Generalized estimating equations were employed to examine the relationship of pregnancy complications and copayments with prescription fills of smoking-cessation pharmacotherapies during pregnancy and postpartum. Results Few women filled any prescription for a smoking-cessation pharmacotherapy during pregnancy or postpartum (2.6% and 2.0%, respectively). Having any smoking-related pregnancy complication was positively associated with filling a smoking-cessation pharmacotherapy prescription during pregnancy (OR=1.69, 95% CI=1.08, 2.65) but not postpartum. Copayments were associated with significantly decreased odds of filling any prescription for smoking-cessation pharmacotherapies in the postpartum period (OR=0.38, 95% CI=0.22, 0.66). Conclusions Smoking-related pregnancy complications and substance use are predictive of filling a prescription for pharmacotherapies for smoking cessation during pregnancy. Low use of pharmacotherapies during pregnancy is consistent with clinical guidelines; however, low use postpartum suggests an unmet need for cessation aids in Medicaid populations.