Insurance Coverage for Medical Cannabis Still a Long Way Off

Every patient who purchases medical cannabis at the Beehive Farmacy in Brigham City, UT, pays for it out of pocket. Medical insurance doesn’t cover it. Neither do Medicare and Medicaid. As much as patients probably hope and pray that this will change soon, it is not likely to. Insurance coverage for medical cannabis is still a long way off.

Beehive Farmacy’s operators say there are two big hindrances. The first hindrance may be taken away within the next year or so. The second one could take decades to resolve. In all likelihood, we won’t start seeing insurance coverage for medical cannabis for a long time to come.

The First Hindrance: Federal Law

Medical cannabis may be legal in more than three dozen states and several territories, but it is still a Schedule I controlled substance under federal law. That means it is still illegal. As long as it remains so, there’s no hope of insurance carriers covering medical cannabis ‘prescriptions’. Choosing to pay for medical cannabis despite its federal status only jeopardizes an insurance company’s future. It is not going to happen.

It should be noted that all the substances on Schedule I are so designated because the federal government believes they have no legitimate medical uses and have a high potential for addiction. The addiction issue is one we have been debating for decades. As for legitimate medical uses, that leads directly to the second hindrance.

The Second Hindrance: FDA Approval

The federal government sets the standards under which both Medicare and Medicare operate. The two public health insurance options can only cover prescription medications that have been approved by the FDA. Private insurance companies generally follow the same policies established by Medicare and Medicaid. So if Medicare and Medicaid will not cover a drug, neither will insurance companies.

Here’s the issue: getting FDA approval for a new drug is not an easy process. It is also not fast. A pharmaceutical company can spend more than a decade conducting the tests necessary to convince the FDA. So even if lawmakers were to remove marijuana from Schedule I today, we are probably looking to at least a decade before the FDA would approve medical cannabis for specific conditions.

Until Medicare and Medicaid get the official green light from the FDA, they will not cover medical cannabis. The same goes for most private insurance companies. At this point, it would seem that the only way to make medical cannabis more affordable is for states to subsidize sales. But that’s not going to happen, either. Nor should it.

Out of Packet, at Least for Now

Patients will have to continue paying for medical cannabis out of pocket, at least for now. There are rumors that federal lawmakers are getting ever closer to a compromise that would either reschedule or decriminalize marijuana. Should that ever happen, it will mark a first step toward eventual insurance coverage. But it would also mark the beginning of a long and arduous process to get the FDA onboard.

Perhaps the FDA could be convinced to dispense with its normal approval processes in order to give an immediate green light to medical cannabis. But that’s asking a lot. Once Washington opens the door to setting aside its rules to make one constituency happy, it is hard to close those doors again.

We have rules and regulations in place for a reason. Perhaps they are onerous and unwarranted most of the time. But they still constitute the rules by which the game is played. Until the rules are changed, medical cannabis will not be covered by private insurance or public health plans.

About Terry J. Patterson

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