Over the past decade, medical marijuana has gained significant ground as a valued treatment option for hundreds of different health conditions in nearly every part of the body. It has been proven to ease pain levels in cancer patients, control symptoms for patients with inflammatory bowel disease, help patients cope with post-traumatic stress disorder (PTSD), and so much more.
While medical marijuana has garnered mass support from doctors and patients, as well as a growing body of evidence which indicate the benefits of its use, patients still need to consider how to pay for it.
So is Medical Marijuana Covered by Health Insurance Plans?
The short answer is no.
First, both medical and recreational marijuana are classified as illegal controlled substances in the eyes of the federal government. Marijuana is a Schedule I drug according to the Controlled Substances Act. This class of drug is defined as having no medical value and a high danger of addiction.
It is unlikely insurance companies will cover medical marijuana with this federal law in place. For instance, Medicare and Medicaid are part of the Centers for Medicare and Medicaid Services, which is a federal entity governed by federal law. This means Medicare and Medicaid cannot cover medical marijuana at this time.
Additionally, FDA approval is another obstacle medical marijuana must overcome before being covered by health insurance. In general, insurance companies will not cover a drug that has not obtained approval by the FDA.
Although the regulatory body has not taken any steps toward approval, it has been vocal about supporting medical marijuana research. The FDA does work alongside the Drug Enforcement Administration (DEA) and National Institute on Drug Abuse (NIDA) to support clinical research of medical marijuana.
Attempts to Approve Medical Marijuana for Insurance Coverage
In some states, however, some forms of change has taken place.
For example, The New York State Department of Financial Services, Health Bureau, recently clarified insurance law concerning medical marijuana in the state, requiring insurers to pay for office visits related to medical marijuana. However, insurers do not have to cover the actual medical marijuana when it is obtained from the dispensary.
In 2017, a New Jersey judge made a landmark ruling in a workers’ compensation case regarding a lumber worker’s legal use of medical marijuana to treat neuropathic pain in one of his hands. The judge ruled workers’ compensation would have to cover the costs of his medical marijuana.
What Patients Can Do
Due to the current landscape, medical marijuana patients ultimately have two choices: pay for medicinal marijuana out of pocket or use drugs covered by their insurance plan.
Out-of-pocket costs vary greatly depending on how much medical marijuana you require to control your symptoms, the grade of cannabis, and the area you live. According to the Medical Marijuana Association, the average cost for legal marijuana sold by a government program is approximately $15 per gram. Furthermore, costs vary based on what type of marijuana product you wish to purchase, such as edibles or bottled tinctures.
If patients do not want to pay out of pocket or cannot afford the price of medical marijuana, there are several legal, FDA-approved synthetic cannabinoids that health insurance does cover. These alternatives to medicinal marijuana include Marinol (dronabinol) and Cesamet (nabilone). Both options contain manmade THC, which is a natural chemical component in cannabis.
The FDA has approved Marinol to treat nausea and vomiting related to chemotherapy, as an appetite stimulant in AIDS patients who suffer from weight loss, and manage pain in people with multiple sclerosis. Cesamet is approved by the FDA for similar indications. Patients need to check with their insurance policies to make sure it will cover these specific drugs.