NOw Available for california Medi-Cal Particpants

No-Cost Nicotine Replacement Therapy (NRT) Kit

Fully covered by Medi-Cal at no out-of-pocket cost.

Complete Your Request — It’s Quick & Secure

Takes Just A Few Minutes To Complete

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Please enter in MM-DD-YYYY format

Where Should We Send Your Quit Kit?

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Tobacco Use History
(This helps our pharmacist choose the right support for you)
(3/6)

If none, please type none
Please select all that apply
If none, type none

Helping You Get the Right Care
(Safety questions required before nicotine replacement therapy)
(4/6)

If none, type none
If none, please type none
If none, please type none

Last Step! Authorization:
(6/6)

Warning: Before taking any medications or over-the-counter drugs, consult a physician for a thorough evaluation. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition. Do not take medication if you have a known allergy to it.

SMS Consent Options (required by A2P 10DLC):

This questionnaire is available in multiple languages upon request.
¿Necesita el formulario en español? Pídaselo al farmacéutico.
هل تحتاج النموذج باللغة العربية؟ اطلبه من الصيدلي.

HOW IT WORKS

Many individuals aren’t aware of what support options may already be available to them.

This quick check helps determine what you may qualify for and how to get started.

Quick Check

Complete your quick check

Answer a few simple questions to get started.

Review Check Icon

Our Team reviews your request

Your information is securely reviewed.

Support Delivered to Your Door con

Support Delivered to Your Door

If approved, support is arranged for delivery.

Our No-Cost Nicotine Replacement Therapy (NRT) Kit includes:

  • Nicotine Gum and Patches – to help reduce cravings associated with quitting smoking, vaping, or using smokeless tobacco.

  • Vitamin C and Vitamin D Supplements – to support your body during the withdrawal process.​

  • Magnesium Supplement – to promote better sleep while quitting.

  • Tylenol (Acetaminophen) – to relieve headaches and body aches.​

  • COVID-19 Test Kit – included for added health support.

Refill available once per month — 100% covered by Medi-Cal

STILL NOT SURE?

Frequently Asked Questions

We know you may have questions, and we’re here to help! Below are some of the most common questions about our program, how eligibility works, and what you can expect. If you need further assistance, feel free to reach out to our support team.

Who is eligible for this program?

Eligibility is based on residency and health coverage status. To determine if you qualify, simply complete our secure eligibility request form. It only takes a minute!

Does this program cost anything?

There is no out-of-pocket cost for eligible participants. Our stop smoking kits are available to qualified individuals through approved health program.

What’s included in the No-Cost Nicotine Replacement Therapy (NRT) Kit?

🟩 Nicotine Gum and Patches – helps reduce cravings💊 Vitamin C + Vitamin D – supports your body during withdrawal🌙 Magnesium Supplement – promotes better sleep while quitting💊 Tylenol (Acetaminophen) – relieves headaches and body aches🧪 COVID-19 Test Kit – included for added health support🌀 Refill available once per month — 100% covered by Medi-Cal

How do I check my eligibility?

Checking your eligibility is simple! Click the button below to complete our quick and secure HIPAA-compliant request form. Our team will review your information and notify you of the next steps.

How long does it take to receive my Stop Smoking Kit?

Once your eligibility is confirmed, we will process your request as quickly as possible. Delivery times may vary based on processing and shipping availability.

How is my information protected?

Your privacy is our priority. We use a HIPAA-compliant system to securely process your information, ensuring that it is encrypted and handled with the highest standards of privacy and security. Your details will never be shared without your consent.

Your information is confidential and protected under HIPAA regulations. This program does not provide medical advice, diagnosis, or treatment. Always consult a healthcare professional for any health-related questions.

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