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Free vs. Fee-based Smoking Cessation Benefits: Which Work Better?

Free vs. Fee-based Smoking Cessation Benefits: Which Work Better?

It’s a small investment for an employer to provide smoking cessation benefits to employees. But the evidence is quite strong that it makes a big difference.

According to researchers at the University of Ohio, $5,816 year is the average cost per employee who smokes, when compared to a non-smoker. The increased annual cost per employee is due to higher absenteeism, lower productivity, and higher healthcare costs. (The analysis even considered the savings in pension funds to the employer because smokers tend to die younger.)

From more than 30 studies, employer-based programs are shown to improve workforce health and reduce costs, especially if the worksite program is focused specifically on smoking cessation.

The most successful stop-smoking programs include both medications and behavioral support. Support can be provided in-person, via telephone, or most conveniently through web-based interventions. There also are a variety of ways to make the right quit-smoking medications available to employees.

When discussing the best way to offer smoking cessation benefits to employees, employers frequently ask 2 questions:

  • Doesn’t a person need to be ‘ready to quit’ to benefit from a smoking cessation program?
  • Does charging a fee or co-pay encourage each participant to be more invested in a smoking cessation program?

The answers to both questions may be counterintuitive; however, they should be considered when designing cost-effective employee smoking cessation benefits.

Ready vs. not ready to quit smoking

A recent study in the American Journal of Preventive Medicine found that people who smoke did not need to be ‘ready to quit’ in order to benefit from a smoking cessation program.

Most people who smoke want to quit eventually; but, for a variety of reasons, most don’t want to make a commitment or short-term plan to quit now. Maybe the time doesn’t feel quite right, it may feel too difficult, or they may be discouraged because of past failed efforts.

Whatever the reason, involving people in a program without requiring that they ‘be ready’ serves to help increase the likelihood that they will make a quit attempt.  We don’t require diabetic patients to be ready to eat better or exercise as a prerequisite to treatment for diabetes, for example. The same should hold true for patients with tobacco use disorder.

Free vs. co-pay for smoking cessation benefits

How about cost sharing for treatment?

The Centers for Disease Control and Prevention recommend that smoking cessation treatment be provided to smokers without cost or co-pay.

The evidence is clear that cost-sharing and even small co-pays can reduce participation in smoking cessation programs, and that results in fewer people successfully stopping. In line with this, the Federal Employee Health Benefits plans have been providing full coverage for tobacco cessation counseling and medications since 2011.

Employers can make a huge difference in employee health, and in their bottom line, through providing comprehensive coverage for employees who smoke.

The EX Program personalizes quitting for each tobacco user, where ever the tobacco user is in the journey. Plus, the EX Program delivers free quit medication to the participant’s home, making access easy. Visit the program page to learn more or contact us to see a demo today.


Michael Michael Burke, EdD, Mayo Clinic Nicotine Dependence Center
Michael Burke, EdD, Mayo Clinic Nicotine Dependence Center

Program Director

Dr. Burke has more than 20 years of clinical experience in treating tobacco dependence. At the Mayo Clinic, Dr. Burke supervises a program that treats more than 2,500 patients and educates more than 400 health professionals per year. He is an Assistant Professor of Medicine in the Mayo College of Medicine and the coordinator for the Mayo Clinic Nicotine Dependence Center.

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