23 MAC Pt. 200, R. 5.4
Tobacco Cessation
Cite as 23 Miss. Admin. Code Pt. 200, R. 5.4
Tobacco Cessation
A. The Division of Medicaid covers up to twelve (12) in-person or telehealth tobacco cessation
counseling sessions per State Fiscal Year, when provided by:
1. A physician, or
2. Other licensed practitioner that has prescriptive authority, operating within their scope of
practice.
B. Tobacco Cessation Medications - The following types of tobacco cessation medications are
covered in the Mississippi Medicaid program:
1. Over-the-counter nicotine products,
2. Legend or prescription nicotine replacement products,
3. Bupropion Hydrochloride, and
4. Varenicline Tartrate.
B. A physician’s prescription will be required for all legend and over-the-counter tobacco
cessation medications. Each prescription will count toward the monthly limit.
C. The Division of Medicaid will monitor the beneficiary’s utilization of tobacco cessation
products for over utilization or misuse; and in instances where there are patterns suggesting
over utilization or misuse, the prescribing physician(s) will be contacted for justification of
medical necessity.