Canadian Armed Forces Military Personnel Instruction 04/04 – Reimbursement for Smoking Cessation Pharmacological Therapy

Identification
Abbreviations
Policy Direction
Re-imbursement Criteria
Responsibilities
References
Annex

1. Identification

Date of Issue: 2004-04-03

Date of Modification: 2024-12-01

Application: This Instruction applies to officers and non-commissioned members (NCM) of the Canadian Armed Forces (“CAF Members”)

Approval Authority: Chief of Military Personnel (CMP)

Enquiries: Administrative Response Centre (ARC)

2. Abbreviations

Abbreviation	Complete Word or Phrase
CF H SVCS GP	Canadian Forces Health Services Group
CF SoC	Canadian Forces Spectrum of Care
CMP	Chief Military Personnel
MO	Medical Officer
NRT	Nicotime Replacement Therapy
UMO	Unit Medical Officer

3. Policy Direction

Policy Statement

3.1 CAF members will be reimbursed for specifically approved pharmacological therapy as described in this Instruction, in accordance with the CF SoC.

Context

3.2 It is the intent of CF H SVCS GP to ensure that CAF members are able to achieve the full benefits of pharmacological therapy to assist in achieving smoke-free status while minimizing the consequences of possible side effects and promoting cost effectiveness.

Smoking Cessation Programs

3.3 The CAF actively promotes healthy lifestyles and offers risk reduction programs to all serving members. The CAF currently funds a smoking cessation program (Butt Out), which is offered to all of its smoking members. This program utilizes Zyban® or NRT, however, members are not required to take either medication. NRT includes nicotine chewable pieces and patch.

Behavioral Counselling

3.4 Research indicates that smoking cessation programs are more effective when behavioral counselling programs are included. There is a significant increase in the success rate.

Nicotime Replacement Therapy in Operational Situations

3.5 In those operational situations where potential participants cannot participate in a full Butt Out program, a modified version of the program may be conducted involving NRT in accordance with instructions given out in Butt Out facilitator training.

Side Effects

3.6 Because of the potential for serious side effects and the potential for significant impact on the member’s ability to perform work, a questionnaire (sample at Annex A) must be completed at weeks 2 and 4 of the smoking cessation program.

Operational Constraints

3.7 Due to the severity of side effects reported, impact on ability to work and the requirement for medical consultation, Zyban® is not authorized for use in

Operational theatres,
Deployed areas, or
On ships where full medical support (physician) may not be available

3.8 In these cases, NRT may be prescribed at the discretion of the Medical Officer.

4. Re-imbursement Criteria

Criteria Table

4.1 The table below describes the re-imbursement criteria for approved adjuvant.

If a CAF member is	Then
Enrolled in the CAF smoking cessation program ("Butt Out")	A course of treatment is approved for up to three months in conjunction with attendance in the CAF smoking cessation program (Butt Out). The member will be eligible for reimbursement of more than one pharmacological therapy treatment per calendar year if more than one course of the Butt Out program is attended in that calendar year. For patients using NRT, a treatment course may be shorter than 3 months, but regardless of the length of treatment, this will constitute one attempt. Pharmacological therapy medication will be dispensed in two-week supplies to prevent waste and facilitate tracking of effectiveness and adverse events. Prescriptions for pharmacological therapy must not be filled at DND pharmacies without certification of participation in a Butt Out program. In situations where CAF members request more than one pharmaceutical aid, the cost of only one of the smoking cessation therapies will be reimbursed at Crown expense.
Enrolled in an equivalent civilian smoking cessation program	A course of treatment is approved for up to three months in conjunction with attendance at a CF H SVCS GP recognized counselling program, smoking cessation program or support group. CF H SVCS GP will review and approve alternative smoking cessation programs to ensure comparability with the Butt Out Program. The following information must be provided: Name of the program, Where it is being offered, Member’s other medical conditions that require immediate initiation of smoking cessation therapy, and Reasons why the member is not participating in the Butt Out program.
Not enrolled in a smoking cessation program	The CAF will reimburse the cost of NRT or Zyban® (up to a three-month supply per year) if the member is able to remain smoke-free for a period of one year.

Self-directed Programs

4.2 Many people quit smoking on their own relying on sheer will power. The CAF offers a self-help guide to assist members interested in pursuing this option. Members must have their prescriptions for NRT or Zyban® filled at their own expense using civilian pharmacies. Research shows that having the patient pay up front for the therapy increases the chances of success by enhancing the patient’s commitment; however, if this option is pursued, members must advise their appropriate CAF medical authority through their Medical Officer (MO).

Reimbursement for Self-directed Programs

4.3 Members who have remained smoke-free for a period of 12 months will be reimbursed costs using a General Allowance Claim CF 52. Members must provide the original copy of their receipt and a witnessed statutory declaration from the member confirming that they have been smoke-free for a period of 12 months after initiating pharmacological therapy. (This is retroactive to include drugs purchased after 01 Jan 99.) Reimbursement will be limited to one course of therapy per year for either NRT or Zyban®.

5. Responsibilities

Responsibility Table

5.1 The table below identifies the responsibilities for implementing this policy.

The...	has or have the responsibility(ies) to:
CMP	Authorizing Director General Health Services (DGHS) to conduct smoking cessation programs for CAF members.
Deputy Chief of Staff Medical Policy (DCOS Med Pol) Pharmacy Policy and Standards (Pharm Pol & Stds)	Developing and issuing instructions to implement the policy. Establish standards to ensure quality re-imbursement services for smoking pharmacological therapy.
UMOs	Implementing the policy covering re-imbursement for smoking pharmacological therapy.
CAF member	Deciding to quit smoking and taking appropriate action.

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