TeamstersCare Chantix® (smoking cessation medication) Coverage
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Governs coverage and copayment reimbursement process for Chantix (smoking cessation medication) for TeamstersCare members, retirees and their dependents eligible for prescription benefits; describes where and how Chantix may be obtained and how to submit reimbursement claims.
No material clinical or coverage changes in this revision.
Chantix Coverage and Reimbursement Criteria
Chantix coverage and reimbursement criteria
Coverage and reimbursement requirements for Chantix:
ALL of the following
- Member must be eligible for TeamstersCare prescription drug benefits (active members, retirees, or dependents).
- Obtain two prescriptions from your medical provider: one for a Chantix starter pack and a separate prescription for a two-month Chantix continuing pack (together totaling a 12-week supply).
- Fill the prescriptions only at a TeamstersCare pharmacy or through Medco/Express Scripts mail order; Chantix is not covered at retail pharmacies.
- Submit a completed TeamstersCare Chantix Copayment Reimbursement Claim Form with legible itemized prescription receipts showing patient name, medication name, prescribing provider, date of purchase, RX number, and total charge including copayment.
- All prescription copayment reimbursement requests must be received within 12 months of the prescription fill date.
ALL of the following
- Coverage limit: Maximum coverage: up to two 12-week courses in a 12-month period.
- If a second 12-week course is needed, obtain another prescription, fill at an approved location, and submit the second copayment for reimbursement.
Coding and Quantity Limits
| No codes listed |
Prescribing, Fill Locations, and Reimbursement Submission
Prescribe two separate Chantix scripts (starter + continuing)
Contact the member's medical provider and obtain two separate prescriptions: one for a Chantix starter pack and a separate prescription for a two-month continuing pack, which together constitute a 12‑week supply. If a second 12‑week course is needed within the year, obtain another prescription from the medical provider.
- One prescription: Chantix starter pack
- One separate prescription: two-month continuing pack (to complete 12-week supply)
- Obtain a new prescription for any second 12-week course
Fill only at TeamstersCare pharmacies or Medco/Express Scripts
Ensure members fill Chantix prescriptions only at TeamstersCare pharmacies or via Medco/Express Scripts mail order; Chantix is not covered if filled at a retail pharmacy.
- Do not advise members to fill at retail pharmacies—these fills are not covered
- Use TeamstersCare pharmacy locations or Medco/Express Scripts mail order
Submit completed copayment reimbursement form and itemized receipts within 12 months
Advise members to submit a completed TeamstersCare Chantix Copayment Reimbursement Claim Form with legible, itemized prescription receipts within 12 months of the prescription fill date to TeamstersCare Member Services for copayment reimbursement.
- Receipts must be itemized and include patient name, medication name, prescribing provider, date of purchase, RX number, and total charge including copayment
- Cancelled checks, cash register receipts, or charge card receipts are not valid substitutes
- Send form and receipts to TeamstersCare Member Services, Schrafft's City Center, 529 Main Street, Suite 209, Charlestown, MA 02129
Defined Terms
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