Does Insurance Cover Medical Cannabis?

image of a stethoscope and a calculator on top of health insurance forms, hinting that the article is about if insurance covers medical cannabis

Gone are the days when consumers would blindly pop pills just because a doctor prescribed them. Now, people want to know what they’re putting into their bodies and how it’s going to affect them. The search for alternative forms of medicine is constant, and medical marijuana is at the forefront of that hunt. With insurance coverage being a financial necessity, people often wonder: will insurance cover medical cannabis? For the most part, that answer is a resounding no.

Schedule I Substance

Unfortunately, the federal government still views medical cannabis as a Schedule I substance. This is the strictest drug category and it includes highly addictive drugs like heroin. Because of this, insurance companies are not allowed to deal with any form of cannabis due to the fact that it’s federally illegal. Until cannabis is reclassified, things will stay the same, but luckily the FDA recently requested input on cannabis's potential reclassification.

The FDA also took steps that suggest cannabis will not remain a Schedule I substance forever, which in turn means insurance companies might eventually be able to cover the plant. They recently approved the first ever cannabis-derived drug, known as Epidiolex, to treat two rare forms of epilepsy.

Workers’ Compensation

Although insurance companies technically don’t cover medical cannabis, workers’ compensation programs in some states may have to cover the plant. Back in 2000, in New Mexico, a man suffered a permanent back injury while on the job. His doctor then prescribed him medical cannabis and a medical card, and he payed out of pocket for the cannabis. Thirteen years later, he requested his insurer and employer reimburse him. They initially refused until the Court of Appeals agreed with the employee, allowing for him to be reimbursed for the substance even though it was federally illegal.

In New Jersey, a judge ruled that an injured worker's medical cannabis must be covered through their workers' compensation. After going over the case, the judge was intrigued by the positive effects cannabis had on the lumber worker. Not just in its ability to help treat the pain in his left hand, but also the fact that cannabis gave the worker a strong alternative to opiates which have a plethora of negative side effects.

New York Opioid Replacement image of two pill bottles on a white table, one bottle is spilling out prescription pills and the other is spilling cannabis

Recently, the New York State Department of Health filed an emergency regulation that went into immediate effect. It called for medicinal marijuana to be prescribed as an alternative treatment for any condition that would normally be treated with opioids. This would allow doctors to prescribe medical cannabis to many patients with severe pain. Also, patients who are struggling with opioid addiction and who are enrolled in a "certified treatment program" can be prescribed medical cannabis as an opioid alternative.

"Cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson's disease" and about ten other diseases are all ailments doctors could prescribe medicinal cannabis for as a replacement to harmful opioids. The emergency regulations are not permanent, and they’re subject to a 60-day public comment period. And given the public opinion, it’s only a matter of time before this becomes normal medical procedure in the state.

37,000 patients have already been added to New York's medical marijuana program and this new emergency regulation will almost certainly see this number increase. However, the high price of medicinal cannabis in comparison to opioids may keep New Yorkers from jumping ship. One of the registered MMJ companies in New York reported that patients typically spend between $150-$400 a month on medical cannabis. This is compared to a $5 copay the same patients would pay for an entire month’s worth of opiods that would treat the same ailment. The fact that cannabis is not covered by insurance companies may be the only thing that is keeping patients away from the plant and pushing them towards big pharma.

Medical Cannabis In California image of a stethoscope with weed leaves wrapped around it, showing that medical marijuana is legal in some states but insurance companies medical marijuana coverage is nonexistent

The plant may still be federally illegal, but 30 states within the US have now legalized medicinal or recreational cannabis. In some states it even makes more sense to have a medical card to purchase your cannabis as opposed to getting it recreationally.

In California, the pros outweigh the cons when it comes to paying the $40 to $100 needed to purchase a medical recommendation card. For one, patients with a medical card have access to more dispensaries. Only a few dozen dispensaries in California are adult use, which causes for long lines and less supply. The main benefit is the savings medicinal patients receive on taxes. Adult-use patients are forced to pay a 7.25-10 percent tax on their cannabis while medicinal patients have no tax. Even though medicinal patients are still paying out of pocket because their insurance company won't cover medical cannabis, they still receive some benefits.

Will Insurance Companies Ever Cover Medical Cannabis?

Medical cannabis seems to be the new norm when it comes to battling severe illnesses. The majority of states have already legalized or decriminalized medical marijuana and the public opinion seems to be changing for the better.

With cases like the ones in New Jersey, it feels as if we’re moving in a positive direction. Senator Corey Booker has also introduced legislation that would expand access to medicinal cannabis nationwide. This would remove cannabis from the controlled substances list, which would allow insurance companies to cover medical cannabis without fear of prosecution.

The proof is in the plant, and with opioid addiction rising and cannabis becoming the norm, the solution seems obvious. The benefits of cannabis are slowly coming into the light and there is still more to come. Now it’s just time for the federal government and insurance companies to get on board with the majority of the country.

Do you think insurance companies should cover medical cannabis?