smoking cessation products-how long?

[Guest msfixit29]

My co-worker has a client that has been turning in claims for the patch for 6 months. Obviously, he is using this product as a crutch and not actually quitting. I s there anything that gives us the right to say enough! I know that we can say it for buying a lot (stocking up at year end to use up funds) but he is turning in claims monthly. Is there any limits on this?

[oriecat]

I have no actual knowledge on this, this is just my opinion! I think that thinking is wrong. You have no way to know how long this person was addicted to nicotine. Nicotine is a very powerful addiction and could very well take someone a long time to get off of it. If you've been addicted for 20 years, do you think you can successfully kick it in just 6 months? I have no idea, I am not a doctor, that is not my judgment to make. It would be much better for the person to be using the patches than to go back to smoking though.

[jsb]

Other than "stocking up" what limits are there on other OTC medications?

Wish OTC reimbursement had been available 7 years ago when I started chewing nicotine gum on a 12 week "program". Could have taken some pretty hefty deductions over the 5+ years I chewed it. As noted by Oriecat (and by my doctor as I was chewing) using a patch or gum is better than smoking.

I'd reimburse.

[Guest JerseyGirl]

On a strictly person level, I watched both my parents try to stop smoking for most of my childhood, both failed miserably, and as an adult I watched both of them die from smoking related health issues—my father fighting a long battle with cancer, and my mother dead in 3 days from several massive strokes. However long it takes for someone to finally stop is how long you allow the claims to come in and be approved – right up to his last available dime. This may have been this employee’s plan- to use all his 125 plan contributions to finally kick the habit.

As an adjudicator of claims, unless the plan documents specifically state a limit on any given item (which some employers do stipulate), and the usage seems to be in line – the monthly claims would indicate to me that this is not stock piling, which is the only limit set by the IRS, but continued long-term treatment – I can see no reason to deny these claims for as long as the participant has funds available and is providing the proper documentation.

I must admit I am puzzled by the apparent attitude that you and your co-worker have the right to make value judgments during the claims adjudication process. Would you also tell a terminally ill patient with no real hope of a recovery that they have had *enough* chemotherapy if they submitted claims for co-pays for longer than you deemed necessary?