Tobacco cessation treatment in pregnancy: insights from Florida Medicaid claims data

Abstract Introduction Tobacco use increases risk for serious pregnancy complications, increasing infant and maternal morbidity and mortality. Cessation treatments are safe during pregnancy, increase the likelihood of successfully quitting, and decrease risk of negative neonatal health outcomes. All Florida Medicaid plans cover evidence-based cessation treatments. This study analyzed Medicaid claims to better understand cessation treatment utilization for pregnant people enrolled in Florida Medicaid. Methods We analyzed Florida Medicaid claims from 2018 to 2021 to assess utilization of tobacco cessation services among Medicaid beneficiaries with a delivery during the study period. We identified tobacco use status and perinatal episodes using diagnostic and procedural codes; we identified treatment utilization (counseling, pharmacotherapy) using procedural and prescription drug claims. Results We identified 46 512 deliveries for people who use tobacco during the study period, making up 17.5% of all deliveries; among them, 6.3% received Medicaid covered tobacco cessation treatment during pregnancy and 2.4% postpartum. Among those treated, counseling was the most prevalent treatment during pregnancy (61.2%) and pharmacotherapy (nicotine replacement therapy and cessation medication) was the most prevalent treatment (75.8%) postpartum. Conclusion Best practices indicate that clinicians should ask pregnant patients about tobacco use at every visit, document their status, and offer brief counseling and cessation treatment. Despite cessation treatment coverage by Medicaid, our analysis indicates that few clinicians and beneficiaries are using Medicaid coverage for cessation treatment during the perinatal period. These findings suggest an opportunity to increase utilization of covered cessation services for individuals who use tobacco who are pregnant/postpartum, reducing risk factors for morbidity and mortality. Implications This study highlights the gap between tobacco use and the use of Medicaid coverage for tobacco cessation aids among pregnant and postpartum individuals enrolled in Medicaid. Efforts to periodically identify and address barriers to accessing covered cessation services can inform resource allocation to increase cessation support and reduce tobacco use in this population.