ATTENTION: MEDICAID PARTICIPANTS

Ready to Quit Smoking, Vaping, or Chewing Tobacco?

Get monthly support with a No Cost Nicotine Replacement Therapy Kit—covered by Medicaid Programsl.

Medi-Cal Patient Request Form

Utah Medicaid Patient Request Form

How It Works

No shipping fees. No credit card needed.

Just a quick form to confirm your eligibility and we’ll take care of the rest.

Check Your Eligibility & Request Your Kit Now

Checking your eligibility takes just a minute!

California Resident Request Form

Utah Resident Request Form

Your privacy is our priority.

We use a HIPAA-compliant form to securely collect your information, ensuring that your data is protected and handled with the highest standards.

Why Nicotine Replacement Therapy (NRT)?

Real Tools to Fight Cravings—Without Tobacco

Nicotine gum and patches give your body the nicotine it craves

without the harmful chemicals

in tobacco.

They're safe, proven, and approved by the FDA to support quitting.

NRT can help you:

Reduce withdrawal symptoms

Control cravings

Break the habit at your own pace

Note: This program does not provide prescription medications. It includes over-the-counter nicotine therapy products that are safe and effective for most people.

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 wellness kits are available to qualified individuals through approved health program.

What’s included in the NRT Kit?

Every kit includes: ✅ Nicotine gum or lozenges (your choice) Helps reduce nicotine cravings and withdrawal symptoms 📦 Covered 100% by Medi-Cal. No cost to you. 10 Week Program - online checkins required.

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 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.