The Canadian Medical Association Journal said the time has come for health insurance plans and provincial governments to step up and provide coverage for the various drugs needed to help people to stop smoking.
The commentary article was published in the January 22 edition of the CMAJ, titled "Unrestricted public coverage is needed for smoking cessation pharmacotherapies.”
The article was authored by Robert A. Kleinman and Peter Selby, Centre for Addiction and Mental Health, Department of Psychiatry and of Family and Community Medicine at the University of Toronto.
Among the key points in the report are that there are several well-known and effective prescription therapies to help people stop smoking, such as varenicline, bupropion, cytisine and nicotine replacement therapy (NRT).
Regardless of the availability of such low-cost medications, the authors said provincial drug benefit plans restrict coverage for these drugs.
The authors argue that the provinces should remove restrictions on smoking cessation pharmacotherapy coverage within provincial drug benefit plans.
CMAJ wrote that in 2010, it advocated that governments pay for stop-smoking drugs, but even now in 2024 major gaps in prescription coverage still exist.
"Tobacco use is a leading cause of preventable death in Canada, and it is time for governments to ensure that all people with provincial drug benefits have access to smoking cessation medications," said the article.
The authors said there are inconsistencies in the provincial funding that should be resolved so that everyone qualifies for assistance.
"Provincial drug benefit plans, which generally provide coverage for people receiving social assistance or who meet age-or income-based thresholds, restrict coverage for these medications," said the report.
"Coverage for NRT and cytisine is limited, in part, because they are regulated by Health Canada as natural health products. The Ontario Drug Benefit program, for example, generally does not provide coverage for natural health products. Ontario residents can obtain eight to 26 weeks of NRT if they enroll in the Smoking Treatment for Ontario Patients program," the report continued.
The authors of the report also wrote that stop-smoking programs must recognize and accept that smokers often try to quit several times before they are successful.
"Restrictions on smoking cessation coverage in public drug benefit programs do not reflect the relapsing–remitting nature of tobacco use disorder. People often try to stop smoking many times, sometimes more than once a year, before they are able to stop smoking."
The authors said smokers need continuous support in trying to quit.
"These limits result in the differential treatment of people with tobacco use disorder compared with those with other chronic diseases. Medications for most chronic diseases have unlimited coverage in the public drug formularies, with no restrictions on the number of treatment trials per year. People with mental illness and substance use disorders have high rates of smoking and high tobacco-related mortality; restrictions on access to smoking cessation medications disproportionately affect them.
The report said far too much work and money has been spent over the years trying to get people to quit smoking and there should be no reason to continue with policies that restrict that.
"Campaigns to reduce smoking rates over the past 50 years have been an important public health success. However, access to evidence-based medications remains unnecessarily restricted for people covered by provincial drug plans. Closing this coverage gap is a necessary step to ensure that everyone who wants to stop smoking has access to the tools to do so.
A full text version of the CMAJ report can be found online here.
