OBJECTIVES: Tobacco smoking is the leading cause of preventable disease and death in the U.S., and smoking cessation has major and immediate health benefits. The Patient Protection and Affordable Care Act of 2010 (ACA) requires nongrandfathered private health plans (i.e., new plans or those changed substantially since March 2010) to cover certain recommended evidence-based clinical services, including tobacco cessation. A guidance document issued in May 2014 defined these interventions to include cessation counseling and seven Food and Drug Administration (FDA) approved medications without cost-sharing. We evaluated cessation medication costs among private health plans before ACA enactment. METHODS: Data from the 2010 Truven MarketScan^®databases were used to assess average daily reimbursements and copayments of seven FDA-approved medications: five formulations of nicotine replacement therapy (patch, gum, lozenge, nasal spray, and inhaler), varenicline, and bupropion. Average daily reimbursements were defined as the net plan reimbursement divided by the number of days covered by the prescription claim. The sample was limited to pharmaceutical claims from persons aged 35-64 years old (n=438,000). Bupropion claims were restricted to the 150mg 12-hour extended release formulation, the primary formulation recommended for cessation. RESULTS: For non-generic brands, including nasal spray, inhaler, and varenicline, average copayments and daily reimbursements ranged from $27-$38 and $3-$14, respectively. For generic brands, averages ranged from approximately $4-$13 and $1-$4, respectively. Almost all plans (except high deductible plans) required cost-sharing for cessation medications, while both copayments and average daily reimbursements varied widely by insurance plan type. Average daily reimbursements and copayments of cessation medications were generally higher among identifiable plans (109 in total), except for copayments of non-generic brands. CONCLUSIONS: Copayments could be a barrier to patient access of cessation medications, particularly for non-generic brands, among private health plans before ACA enactment. Removing cost-sharing, coupled with promotion of service coverage, might increase the utilization of cessation medications.