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Providing help to pregnant smokers can greatly reduce health care costs for pregnant smokers who succeed in quitting. In fact, for every $1 spent on tobacco treatment during pregnancy, up to $6 can be saved. That’s because the direct medical costs of a complicated birth are 66 percent higher for smokers than for non-smokers, reflecting the greater severity of complications and the more intensive care that is required.

For pregnant smokers, the U.S. Public Health Service (PHS) recommends coverage including:

• Individual evidence-based counseling (the “5 A’s” ) by a trained healthcare professional. For pregnant smokers, this approach has been shown to be particularly successful, doubling our even tripling quit rates in clinical settings.
• Quit smoking aids, such as nicotine replacement, if necessary. (Pregnant smokers who are unable to quit with the help of the “5 A’s” may benefit from recommendations of the general PHS guideline. This guideline recommends intensive counseling from a provider with special training in the treatment of tobacco dependence; such intensive counseling might help heavily addicted smokers to quit. The guideline also advises providers to carefully consider use of medications used to treat tobacco dependence in other populations — nicotine replacement and bupropion — for pregnant women because they have not been tested for safety and efficacy among this population. Pharmacotherapies should be used only for pregnant women who smoke heavily and are unable to quit using counseling methods, and only when the potential benefits and likelihood of quitting are likely to outweigh the potential risks.)

For smokers in general, the U.S. Public Health Service recommends primary care visits for smoking cessation and all pharmaceuticals approved by the U.S. Food and Drug Administration. It’s recommended that low or no copayment be required for cessation visits or for medications such as nicotine replacement products, Zyban and bupropion, both shown to help smokers quit.

In addition, the cost of programs to help people stop smoking and of prescription drugs designed to alleviate nicotine withdrawal and facilitate quitting now qualify as medical expenses for taxpayers who itemize deductions. This enables employees to obtain reimbursement from their flexible spending accounts for such expenses. However, costs for over-the-counter nicotine gum and patches are not deductible or reimbursable. (Note: prescription drugs for nicotine withdrawal, nicotine gum and the patch are not recommended for pregnant smokers.)