{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:50:05Z","timestamp":1781859005955,"version":"3.54.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["P20GM139733"],"award-info":[{"award-number":["P20GM139733"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["P20GM139733"],"award-info":[{"award-number":["P20GM139733"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005280","name":"American Association of University Women","doi-asserted-by":"publisher","award":["International Postdoctoral Fellowship"],"award-info":[{"award-number":["International Postdoctoral Fellowship"]}],"id":[{"id":"10.13039\/100005280","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Smoking prevalence among Medicaid beneficiaries is twice that of privately insured adults, yet effective smoking cessation treatments remain underutilized. Understanding varenicline use, the most effective smoking cessation medication, can inform efforts to improve tobacco treatment for Medicaid enrollees.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To describe varenicline utilization among Kansas Medicaid (KanCare) enrollees from 2014\u20132021, including changes related to the FDA\u2019s December 2016 removal of the black box warning, and explore changes and demographic differences in its use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Research design<\/jats:title>\n<jats:p>This retrospective cohort study analyzed pharmacy claims data for varenicline utilization from January 1, 2014, to December 31, 2021. Tobacco use was estimated from the KanCare External Quality Review survey.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Subjects<\/jats:title>\n<jats:p>The sample included 78,295 new adult enrollees (age 18+) with at least 11 months of continuous coverage.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Measures<\/jats:title>\n<jats:p>The primary outcome was varenicline utilization, defined as any pharmacy claim for the medication. Secondary outcomes included time to first prescription, completion of the 12-week treatment, and demographic differences in use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Results<\/jats:title>\n<jats:p>With an estimated 30% smoking prevalence, only 12.7% of KanCare smokers received varenicline, and just 1.6% completed a full course of treatment. Among 78,295 new enrollees, 2,980 (3.8%) had one or more claims for varenicline, with the mean time from enrollment to first prescription being 1.5 years (SD 1.3). Utilization was higher among males (4.8%) than females (3.4%) and varied by race\/ethnicity (Whites: 4.4%, Blacks: 2.7%, American Indians: 2.5%, Hispanics: 1.6%, p&lt;0.0001). Among those who initiated treatment, only 13.5% (N=380) completed the recommended 12-week regimen.,<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Despite the high smoking prevalence among KanCare beneficiaries, varenicline is underutilized, with significant demographic disparities. Men and non-Hispanic Whites were more likely to receive varenicline than women and other racial and ethnic groups, despite comparable or higher smoking rates among other subgroups. Medicaid programs must intensify efforts to provide equitable and effective tobacco treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333723","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:41:39Z","timestamp":1759858899000},"page":"e0333723","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Utilization of varenicline among Kansas Medicaid enrollees"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6534-2157","authenticated-orcid":true,"given":"Nathalia M.","family":"Machado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J.","family":"Katz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimber P.","family":"Richter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward F.","family":"Ellerbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"issue":"45","key":"pone.0333723.ref001","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.15585\/mmwr.mm6845a2","article-title":"Tobacco product use and cessation indicators among adults - United States, 2018","volume":"68","author":"MR Creamer","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0333723.ref002","volume-title":"The health consequences of smoking: 50 years of progress. A report of the Surgeon General","author":"U.S. Department of Health and Human Services","year":"2014"},{"issue":"14","key":"pone.0333723.ref003","doi-asserted-by":"crossref","first-page":"301","DOI":"10.15585\/mmwr.mm7314a2","article-title":"State Medicaid coverage for tobacco cessation treatments and barriers to accessing treatments - United States, 2018-2022","volume":"73","author":"A DiGiulio","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0333723.ref004","doi-asserted-by":"crossref","first-page":"10","DOI":"10.18773\/austprescr.2022.001","article-title":"Optimal use of smoking cessation pharmacotherapy","volume":"45","author":"C Mendelsohn","year":"2022","journal-title":"Aust Prescr"},{"issue":"3","key":"pone.0333723.ref005","article-title":"Combined pharmacotherapy and behavioural interventions for smoking cessation","volume":"3","author":"LF Stead","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0333723.ref006","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1377\/hlthaff.2015.0756","article-title":"Medicaid tobacco cessation: big gaps remain in efforts to get smokers to quit","volume":"35","author":"L Ku","year":"2016","journal-title":"Health Aff (Millwood)"},{"key":"pone.0333723.ref007","first-page":"435","article-title":"Varenicline for smoking cessation: a narrative review of efficacy, adverse effects, use in at-risk populations, and adherence","volume":"10","author":"MV Burke","year":"2016","journal-title":"Patient Prefer Adherence"},{"issue":"4","key":"pone.0333723.ref008","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/add.13592","article-title":"The food and drug administration and varenicline: should risk communication be improved?","volume":"112","author":"NM Davies","year":"2017","journal-title":"Addiction"},{"key":"pone.0333723.ref009","unstructured":"FDA Drug Safety Communication: FDA Revises Description of Mental Health Side Effects of the Stop-Smoking Medicines Chantix (varenicline) and Zyban (bupropion) to Reflect Clinical Trial Findings. 2016 [Accessed 2024 June 28]. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-revises-description-mental-health-side-effects-stop-smoking"},{"issue":"4","key":"pone.0333723.ref010","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.8727","article-title":"Economic evaluation of enhanced vs standard varenicline treatment for tobacco cessation","volume":"7","author":"MP Mundt","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"9","key":"pone.0333723.ref011","first-page":"1217","article-title":"Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary","volume":"53","author":"2008 PHS Guideline Update Panel, Liaisons, and Staff","year":"2008","journal-title":"Respir Care"},{"key":"pone.0333723.ref012","unstructured":"KanCare program external quality review reports. 2023. https:\/\/www.kancare.ks.gov\/quality-measurement\/external-quality-review-reports"},{"issue":"6","key":"pone.0333723.ref013","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/ntr\/ntaa213","article-title":"Receipt of Cessation treatments among medicaid enrollees trying to quit smoking","volume":"23","author":"X Wang","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"pone.0333723.ref014","volume-title":"Adult smoking disparities in Kansas","year":"2023"},{"issue":"5","key":"pone.0333723.ref015","article-title":"Nicotine receptor partial agonists for smoking cessation","volume":"2016","author":"K Cahill","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"pone.0333723.ref016","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/jnci\/djab208","article-title":"Smoking Cessation prevalence and inequalities in the United States: 2014-2019","volume":"114","author":"AM Leventhal","year":"2022","journal-title":"J Natl Cancer Inst"},{"issue":"2","key":"pone.0333723.ref017","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s40615-023-01558-w","article-title":"Examining racial\/ethnic disparities in tobacco dependence treatment among Medicaid beneficiaries using fifty state Medicaid claims, 2009-2014","volume":"11","author":"MW Flores","year":"2024","journal-title":"J Racial Ethn Health Disparities"},{"issue":"4","key":"pone.0333723.ref018","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1377\/hlthaff.2013.1023","article-title":"Medicaid and marketplace eligibility changes will occur often in all states; policy options can ease impact","volume":"33","author":"BD Sommers","year":"2014","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"pone.0333723.ref019","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1751-7141.2008.00003.x","article-title":"A longer course of varenicline therapy improves smoking cessation rates","volume":"11","author":"JH Lee","year":"2008","journal-title":"Prev Cardiol"},{"key":"pone.0333723.ref020","doi-asserted-by":"crossref","first-page":"100069","DOI":"10.1016\/j.addicn.2023.100069","article-title":"Medication adherence in tobacco cessation clinical trials","volume":"6","author":"KM Walton","year":"2023","journal-title":"Addict Neurosci"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:41:52Z","timestamp":1759858912000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333723"}},"subtitle":[],"editor":[{"given":"Jingjing","family":"Qian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333723","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,7]]}}}