Treatment Recommendations for Tobacco Use

The Standard of Care of tobacco treatment, regardless of the population or the type of tobacco used, is pharmacotherapy and counseling. Appropriate use of tobacco dependence medications reduces withdrawal symptoms and nearly doubles the chances of success for a given quit attempt. Delivering such treatments is cost-effective and is a key part of a multi-faceted approach to help patients stop smoking.

There are seven first-line medications that reliably increase long-term smoking abstinence rates.


  • Nicotine gum
  • Nicotine lozenge
  • Nicotine nasal spray
  • Nicotine patch


  • Bupropion SR
  • Varenicline

Clinicians should also consider the use of certain combinations of medications identified as effective in the Guideline.

  • Long-term (>14 weeks) nicotine patch + other NRT
  • The nicotine patch + the nicotine inhaler
  • The nicotine patch + Bupropion SR

Over-the-Counter Nicotine Replacement Therapy and Medicaid

When prescribing or selecting nicotine patches, gum or lozenges for your a patient/client who has Medicaid, be sure and pick a medication with the proper National Drug Code or NDC.

For a list of all Medicaid covered over-the-counter nicotine replacement therapies with NDC codes click here. Any nicotine replacement therapy not on this list, will not be covered by Medicaid. This may cause confusion and result in your patient not receiving their prescribed and covered tobacco pharmacotherapy. To ensure your patient’s/client’s pharmacotherapy is covered:

1. Call the pharmacy and tell them to use one of the nicotine replacement options on the NDC list.
2. Add in the Notes to Pharmacy section of your NRT prescriptions for Medicaid recipients: “Pharmacy - Please fill with a Medicaid-covered NDC. For a current list call NC Tracks at 1-800-688-6696.”


Key Point: Encourage patients making a quit attempt to use both counseling and medication. Counseling and medication are effective when used by themselves for treating tobacco dependence. However, the combination of counseling and medication is more effective than either one alone.