Acknowledgments  v

Executive Summary  vi

Key Findings  vi

Policy Implications and Recommendations  vi

Treatment for Tobacco and Nicotine Use Disorder in Medicaid  1

Medicaid's Role in Addressing Tobacco Use Disorder and Nicotine Dependence  2

Research Gaps and This Study's Objective  3

Methods  3

Data Sources  3

Cessation Medication Measures  4

Identifying and Classifying Cessation Medications in Medicaid SDUD and Medicaid Claims  6

Estimated Measures of Daily Tobacco or Nicotine Use Among Adult Medicaid Enrollees  7

Estimated Medicaid Treatment Rates  8

Study Design and Statistical Analysis  8

Limitations  9

Findings  11

Overall Prescription Volume Held Relatively Steady Although Use Shifted Toward NRTs and Away from Varenicline, 2019 to 2025  11

Shift Toward NRTs and Away from Varenicline: Marked Changes in Medicaid Cessation Medication Use from 2019 to 2025  13

Fewer Medicaid Enrollees with Daily Tobacco or Nicotine Use Received Cessation Medications in 2025 Than in 2019  14

Fills for Cessation Medications in Medicaid Varied More Than Sixfold Across States in 2025  15

States That Expanded Medicaid Earlier Reached More Adults with Daily Tobacco or Nicotine Use with Cessation Medications Than Nonexpansion States in 2025  16

Discussion  20

Persistent Barriers to Medicaid Cessation Treatment and Strategies to Address Them  20

Leveraging Medicaid and Other Policy Levers  21

Broader Policy and Funding Uncertainty Surrounding Tobacco and Nicotine Regulation and Medicaid Cessation Coverage  22

Conclusion  23

Appendix. Additional Methods  24

Notes  30

References  34

About the Authors  38

Statement of Independence  39