Smoking Cessation Products: HSA Eligibility

Revenue Ruling 99-28; Notice 2010-59

How do smoking cessation products work?

Most of the smoking cessation products found over-the-counter utilize a form of nicotine replacement therapy, in which smokers start with a high concentration of nicotine, and gradually step down over time to smaller increments until they do not need the products at all. The most common products include via Verywell Mind:

• Nicotine Patches: These small, adhesive patches slowly release nicotine through the skin and into the wearer's body. They are changed daily and typically worn for 8 to 12 weeks.
• Nicotine Gum: These pieces of gum carry a small amount of nicotine that is absorbed into the body through the mouth, and can be taken every 1 to 2 hours and treatment typically lasts 12 weeks or more.
• Nicotine Lozenges: Similar to nicotine gum, these lozenges allow nicotine to be absorbed through the mouth and into the bloodstream. Up to 20 can be taken each day. These lozenges also prove effective after 12 or more weeks of use.
• Nicotine Inhalers: These small inhalers emit a nicotine vapor via a cartridge in the device that is designed to control sudden cravings and withdrawal symptoms, and can sometimes be used in conjunction with other smoking cessation products. Typically, a smoker will average about a dozen cartridges per day for 12 weeks, and gradually taper down to none over the next six to 12 weeks.
• Nicotine Nasal Spray: This nasal spray delivers a small dose of nicotine into the nostrils and can be used one to three times each hour. This treatment can last anywhere from three to six months.

In addition to nicotine replacement therapy, a number of prescription smoking cessation products have also hit the market in recent years that do not use nicotine and instead manipulate brain chemistry to reduce cravings and mitigate the withdrawal process. Two of the most common products include:

• Bupropion (Zyban): Bupropion is an antidepressant, but in its sustained-release form, it is approved by the FDA as a means of smoking cessation. Bupropion works by altering some chemicals in the brain to reduce cravings and various withdrawal effects. The drug is usually taken for 12 weeks, and can be continued for weeks afterward to prevent smoking relapses.
• Varenicline (Chantix): Varenicline differs from buproprion by targeting individual nicotine receptors in the brain. With these receptors blocked, the pleasurable sensations associated with satiating a nicotine fix are removed, which reduces withdrawal symptoms, cravings and makes smoking less desirable overall. Varenicline is taken for 12 weeks, and can be continued after this period to avoid smoking relapses.