Cost of Nicotine Replacement Therapy

More than half of smokers identified product cost as a barrier.17*

However, patients may not realize that the cost of NRT is comparable, and often lower than cigarettes. Although smokers may not always equate the cost of cigarettes (“pleasure”) with the cost of NRT (“punishment”), saving money can be a good motivator for quitting.

*2262 smokers in Ontario recruited from July 2005-June 2007 participated in a telephone-based survey.

The comparative cost of quitting

Cigarettes vs. NRT

  Cigarettes43 NICODERM® Patch44 NICORETTE® Gum44§ NICORETTE® Lozenge44¡¡ NICORETTE® Inhaler44 NICORETTE® QuickMist®44**
20 cigarettes per day $11.49 $3.61 (based on one
patch per day)
$5.52 (based on 15-4 mg pieces of
gum per day)
$6.14 (based on 15-4 mg lozenges per day) $5.58 (based on 6.10 mg cartridges per day) $9.44 (based on 40
sprays per day)
10 cigarettes per day $5.75 $3.61 (based on one patch per day) $5.52 (based on 15-4 mg pieces of
gum per day)
$5.46 (based on 15-4 mg lozenges per day) $2.79 (based on 6-10 mg cartridges per day) $4.72 (based on 40
sprays per day)

Reimbursement coverage

Updated map of coverage from the Canadian Partnership Against Cancer

Public coverage

Summary of public reimbursement for smoking cessation treatment across Canada

Province
Coverage
BC
  • Eligible residents can be covered for one of the following: 1) NRT products OR 2) Prescription smoking cessation drugs

1) All residents with a valid provincial health card are eligible to receive 12 weeks annually of cost-free NRT through the BC Smoking Cessation Program; participants must register via telephone and choose to pick up their 4 week allocation of NRT at any community pharmacy or have it delivered by mail (no prescription is required).

  • Effective April 1, 2017, the BC Smoking Cessation Program covers: NICORETTE® Gum (2 mg, 4 mg), NICORETTE® Mini Lozenge (2 mg, 4 mg), NICORETTE® Inhaler (10 mg) and the NICODERM® Patch (7 g, 14 mg, 21 mg)

2) BC Pharmacare reimburses eligible members for either bupropion or varenicline for 12 consecutive weeks per 12-month period.
Under exceptional circumstances, PharmaCare may cover a course of NRTs in the same calendar year as a prescription drug by a Special Authority request.
Click here for the most up-to-date information.

AB
  • AB public drug plans (AB Drug Benefit List, AB Human Services Drug Benefit Supplement or the Palliative Coverage Drug Benefit Supplement) reimburses members for 12 weeks of bupropion and varenicline annually. An additional 12 weeks of varenicline is available with special authorization from a physician.
  • AB Health Services QuitCore program offers Albertans 18+ years of age no-cost NICODERM® patch, and NICORETTE® Gum, inhaler, mini lozenge and QUICKMIST® up to a lifetime maximum of $500. Also, patch may be combined with an oral format.

Click here for the most up-to-date information and view dosing guidelines here

SK
  • SK Public Drug Program reimburses members (>65 or on social assistance) for bupropion and varenicline. For varenicline, members are limited to 12 weeks of treatment annually.

Click here for the most up-to-date information.

MB
  • MB Pharmacare reimburses members for bupropion and varenicline. For varenicline, coverage is limited to 12 weeks (165 tablets/benefit year).
ON
  • The Ontario Drug Benefit program provides reimbursement for bupropion and varenicline for smoking-cessation treatment, in conjunction with smoking-cessation counselling, for Ontario Drug Benefit-eligible recipients (i.e., Ontarians ≥65 years of age, recipients of Ontario Disability Support Program or Ontario Works, residents of long-term care homes or homes for special care, Ontarians receiving home care services, and Ontarians registered in the Trillium Drug Program). Treatment with each agent is limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient.
    Find pharmacies in your neighbourhood
  • STOP Program: Ontarians can access limited NRT through workshops hosted across the province by CAMH in partnership with local community partners and sponsored by the Ministry of Health and Long Term Care, Smoke Free Ontario Branch. Please visit stopstudy.ca and click on STOP on the Road for more information.
QC
  • Régie de l’assurance maladie du Québec reimburses members for bupropion, varenicline and NRT patch, gum and lozenge, if obtained by prescription.
  • Members can receive NRT reimbursement for a maximum of 12 consecutive weeks per 12-month period (max. 840 lozenges or pieces of gum). During the same 12 weeks, both patch and gum/lozenges may be reimbursed together if written on the same prescription.
  • Bupropion and varenicline are also covered for 12 consecutive weeks per 12-month period, whether or not they are used at the same time as the nicotine patches and gum or lozenges. For varenicline, coverage may be extended by 12 weeks, provided that one has stopped smoking.
  • All employer sponsored drug plans are required to provide comparable reimbursement for stop smoking medications as the government plan. Plan members can ask their insurer, employer or pharmacist about which products are covered and for how long.

Click here for the most up-to-date information.

NB

Click here for the most up-to-date information.

PEI
  • A Quit Smoking program is available for eligible PEI Medicare plan members (>65 or on social assistance); it covers the first $75 (per year) of cost for varenicline, bupropion or NRT. Note: The Premier recently committed to rolling out a new program.

Click here for the most up-to-date information.

NS
  • NS Pharmacare reimburses members for bupropion.

Click here for the most up-to-date information.

NF
  • A provincial smoking cessation program is available for individuals with low income or >65; it covers varenicline or bupropion for up to 12 continuous weeks, once every 12 months.

Click here for the most up-to-date information.

Non-Insured Health Benefit Plan (NHIB)
  • The NIHB reimburses plan members (eligible registered First Nations and recognized Inuit) for bupropion, varenicline and NRT (gum, inhaler, lozenge, patch) on an annual basis. Recipients are eligible to receive up to 3 treatment courses of NRT within a 12-month period with quantity limits, which include two courses of NRT patches and one course of NRT products used PRN (i.e. gums, lozenges, inhalers).
  • Varenicline is limited to 165 tablets during a one-year period.
  • Bupropion is limited to 180 tablets per year.
  • NRT: Nicotine gum and lozenges are covered for 945 pieces per year. The NICORETTE® Inhaler is limited to 945 doses per year. Nicotine patches are limited to 140 patches for NICODERM® and 168 patches for Habitrol® per year.

In all provinces, members of the Funding for Smoking Cessation Aids on the Public Service Health Care Plans are eligible for reimbursement for all smoking cessation aids to a maximum lifetime limit of $1000.

Combination Therapy

Summary of public reimbursement across Canada

British Columbia

All residents with a valid provincial health card are eligible to receive 12 weeks (84 days in a row) annually of cost-free NRT through the BC Smoking Cessation Program.
As of January 1, 2016, patients can:

  • Access an expanded selection of NRTs, as noted below.
  • Sign up for the B.C. Smoking Cessation Program at their local community pharmacy. They no longer need to call HealthLink BC for this service.

The B.C. Smoking Cessation Program covers:

  • NICORETTE® Gum (2 mg, 4 mg)
  • NICORETTE® Lozenge (2 mg, 4 mg)
  • NICODERM® Patch (7 mg, 14 mg, 21 mg)
  • NICORETTE® Inhaler (10 mg)
Ontario

In Ontario, patients on Family Health Team (FHT) Rosters, Family Health Organizations (FHO) and some Community Health Centres and Public Health Units are eligible for the CAMH STOP program, which provides free NRT as either monotherapy or combination therapy.

Quebec

In Quebec, if two NRT formats (e.g. patch + gum) are included on the same prescription, RAMQ will reimburse for the combination.

In Other Provinces

In other provinces where one format is covered, consider advising your patients to purchase the second format themselves.

Coupons are available to help defray the cost.

Privately sponsored drug plans

Some privately (i.e. employer) sponsored drug plans provide reimbursement for prescription requiring stop smoking treatment (varenicline and bupropion), generally with a modest lifetime dollar maximum. Very few privately sponsored drug plans provide reimbursement for nicotine replacement therapy; however reimbursement can be obtained through health care spending accounts where applicable.

Percentage of plan subscribers with smoking cessation product coverage under The Great-West Life Assurance Company and Sun Life Financial drug plans55

Province Varenicline Bupropion Nicotine Patches Nicotine Gum
BC 56% 54% 23% 23%
AB 62% 60% 17% 17%
SK 74% 73% 14% 14%
MB 66% 52% 27% 27%
ON 60% 59% 18% 20%
QC 100% 100% 100% 100%
NB 65% 62% 40% 40%
PE 76% 75% 28% 28%
NS 66% 64% 37% 37%
NF 61% 58% 29% 30%
Canada 68% 66% 34% 35%