Featured Health Business Daily Story, Sept. 30, 2014

Research on E-Cigs Is Needed To Determine Policy Specifics

Reprinted from HEALTH PLAN WEEK, the most reliable source of objective business, financial and regulatory news of the health insurance industry.

By ,
September 22, 2014Volume 24Issue 32

With research on electronic cigarettes scant and federal regulation nonexistent, health insurers are tight-lipped regarding how new data and guidance might affect established smoking policies.

Electronic cigarettes, or e-cigarettes, are battery-operated mechanisms that convert liquid nicotine into vapor, eliminating many of the harmful agents found in tobacco smoke. Little research has been done to determine their potential health hazards, however, and insurers are hesitant to speculate on how or if e-cigarettes could be incorporated into health benefit plans in the future once more is known and forthcoming FDA regulations are in place, market sources say.

Many insurers’ smoking policies incentivize against the use of tobacco by offering their smoke-free beneficiaries lower monthly premiums or rewarding them through wellness programs. Because e-cigarettes have no tobacco, their inclusion in a wellness program could be tricky since members who use them will test positive on the blood cotinine test used to determine smoking habits. But the debate over e-cigarettes’ health risks and their use as a smoking cessation tool could eventually make them attractive to insurers interested in luring their customers away from the destructive elements of conventional tobacco.

Alere WellBeing, which provides wellness programs to more than 750 employers and 28 states, recommends that its clients that test for cotinine levels treat e-cigarettes as a nicotine replacement therapy, similar to employees who test positive because they are using nicotine gum or patches. “Individuals who fall into this category and are randomly selected for nicotine testing should be considered a non-tobacco user and tested at a later date. Clients should develop their own policy for those rare instances where individuals are using e-cigarettes recreationally on a long-term basis (i.e. not as part of a tobacco cessation regime),” Alere advises.

What Are Current Insurer Attitudes?

Some insurance companies, like Cigna Corp., are treating e-cigarettes the same way they treat regular cigarettes, due to their reliance on nicotine. While not considered a carcinogen, nicotine is still considered a potential “tumor promoter” since it alters certain essential biological processes, like regulation of cell proliferation. The vapor also contains traces of other carcinogens, although at levels much lower than traditional cigarettes.

Joe Mondy, a Cigna spokesperson, tells HPW that the company does not offer incentives for use of e-cigarettes over traditional cigarettes, citing the need for more research to determine if any benefit actually exists. He declines to provide any insight into how policy might change if future research determined e-cigarettes are significantly safer than conventional smoking.

Similarly, University of Pittsburgh Medical Center (UPMC) Health Plan Vice President of Medical Affairs Stephen Perkins, M.D., said in a statement that the carrier is holding off on policy revisions due to lack of research, but stressed that a recent employee smoking ban during working hours includes e-cigarettes.

While e-cigarette advocates say the devices have potential as a smoking-cessation technique, no research exists to confirm the claim and the FDA has banned manufacturers from marketing their product as such. Many companies, like Aetna Inc., regard e-cigarettes as a smoking substitute instead of a quitting method. Aetna’s website lists e-cigarettes as an ineligible health expense, saying that an e-cigarette “is not an approved smoking cessation product but rather a replacement.”

FDA Weighs New Regulations

While the FDA now regulates e-cigarettes only as therapeutic devices, in April the agency proposed a rule to extend its control of tobacco and nicotine products to include e-cigarettes for general usage (79 FR 23141, April 25, 2014). The public comment period closed on Aug. 8. FDA spokesperson Jenny Haliski says the agency does not have an estimate on when it will issue a final rule.

Once regulated, the FDA will have the ability to conduct research on ingredient lists and health effects, as well as monitor marketing and advertising. While research is still limited, enough has been done to prompt the World Health Organization (WHO) to issue a report to its member nations in July, summarizing findings.

The report found e-cigarettes still contain toxic elements like formaldehyde and acrolein. But substance levels varied due to the wide range of products available: Some e-cigarettes had a fraction of the toxicants found in many conventional cigarettes, while others had levels as high as certain regular cigarettes.

One major concern of health care advocates is the growing role the tobacco industry has in the e-cigarette market, which was initially created by small, independent companies. If e-cigarette manufacturers hope to market their product as a smoking-cessation tool, the tie to big tobacco, which has a vested interest in maintaining a customer base, could hurt their credibility. WHO reported that all major international tobacco companies now have an e-cigarette product of their own, and one is currently filing suit against its competitors over patents, indicating a more aggressive business strategy.

Another obstacle in the way of a smoking cessation label is the appeal the new products could have to nonsmokers and adolescents. E-cigarettes are currently available in flavors ranging from cola to chocolate, which many say could lure adolescents into the nicotine trap. WHO reported that e-cigarette usage is increasing rapidly among adolescents, although all but a few respondents were also traditional smokers.

The WHO report concluded with a recommendation to ban e-cigarettes in public places and sales to minors, require transparency with regard to the tobacco industry’s involvement in manufacturing and lobbying, place necessary health warnings on marketed products and standardize nicotine levels.

© 2014 by Atlantic Information Services, Inc. All Rights Reserved.

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