Medicaid Covered Services
Prescribe any of the seven approved medications for cessation, if patient is eligible. Approved cessation medications include nicotine patches, gum, lozenges, inhalers, nasal spray, varenicline and Bupropion SR, according to Treating Tobacco Use and Dependence, U.S. Clinical Practice Guidelines, 2008.
Fax BOTH the Alabama Medicaid Pharmacy Smoking Cessation Prior Authorization Request Form and the Quitline referral form to Health Information Design at 1-800-748-0116.
Plan First Recipients do not require prior approval for smoking cessation products. The Smoking Cessation Prior Authorization Request Form should not be submitted for those recipients.
- Medicaid Covered Nicotine Products
- Medicaid Smoking Cessation Prior Authorization Form
- Quitline Fax Referral Form
- Smoking Cessation Medications - Dosing Guidelines for Alabama Medicaid Covered Products
Page last updated: August 15, 2018