Will Medicare Ever Cover Medical Marijuana?

Medical marijuana is becoming increasingly popular among older adults as a treatment for various medical conditions. Despite growing acceptance, however, uncertain safety standards, conflicting laws, and complex regulations could delay Medicare coverage by years.

In April 2022, the Medicare Plans Patient Resource Center conducted a survey showing that 20% of Medicare beneficiaries currently use medical marijuana and nearly a quarter have used it before. The study found that 66% of respondents think Medicare should take over the drug, underscoring the growing interest in this replacement treatment among older people. Consequently, the uncertain status of federal legalization of medical marijuana and FDA approval has called Medicare coverage into question and denied patients this treatment option.

What are the reasons for providing Medicare medical marijuana coverage to seniors?

According to a study published in April 2022 in the journal Cannabis and Cannabinoid Research, a significant proportion (60%) of patients who visited a major cannabis dispensary in New York were aged 50 or older. These patients relied on medical marijuana to relieve various conditions, including cancer, severe or chronic pain, neuropathy, and Parkinson’s disease.

Medical marijuana is also expensive, with edibles costing about $5 per dose and plant buds ranging from $5 to $20 per gram, according to New York Cancer & Blood Specialists, a healthcare provider for patients with blood disorders and cancer. This equates to about $142 to $567 an ounce, making it an expensive treatment option. Unfortunately, even in states where medical marijuana is legal, patients can struggle to afford the prescription.

According to Americans for Safe Access executive director Debbie Chugai, “medicinal cannabis doesn’t come cheap.” Americans for Safe Access is a not-for-profit organization that promotes safe and legal access to therapeutic cannabis and research. While some states can cover the cost of doctor visits or medical marijuana cards, insurance coverage for the products remains elusive.

What federal barriers are impeding medical marijuana coverage?

The path to Medicare coverage for medical marijuana faces two significant hurdles. The first is the federal government’s classification of marijuana as a Schedule I drug. The Drug Enforcement Administration defines Schedule I drugs in the United States as having “no current medical use and a high potential for abuse.” This poses a significant obstacle to the legalization and acceptance of the drug as a medical treatment.

According to Paul Armentano, associate director of the National Association for the Reform of Marijuana Laws (NORML), the federal government will not reimburse medical marijuana through a federal program because it classifies it as an illegal substance.

The second obstacle arises from Medicare’s requirement that the Food and Drug Administration deem a covered drug safe and effective. While the FDA has approved one cannabis-derived drug and three synthetic cannabis-related drugs for prescription use, the agency has yet to approve cannabis for medical treatment.

What is the situation in states where medical marijuana is legal?

While medical marijuana remains illegal at the federal level, 37 states and Washington, DC have legalized its use for medicinal purposes. This raises the question of whether private insurers, like those offering Medicare Advantage plans, might choose to insure medical marijuana.

According to Kyle Jaeger, senior editor and cannabis policy reporter at Marijuana Moment, it’s unlikely that major health insurers will cover medical marijuana. Like banks’ reluctance to offer services to cannabis companies, health insurers are likely to refrain from insuring cannabis as long as it remains a Schedule I drug under federal law.

Additionally, private insurers typically follow FDA guidance when determining which drugs to cover. However, the FDA recently stated that current regulatory pathways are insufficient to classify CBD as a dietary supplement. Kyle Jaeger explains that this situation can frustrate consumers looking for safe and reliable products.

What is the threshold for medical marijuana coverage?

according to dr Benjamin Caplan, founder and chief medical officer of the CED Clinic, which provides treatment services for cannabis, insurers need more data on the medical use of marijuana. He notes that insurers need sufficient evidence to show that cannabis care achieves results comparable to or better than those offered by the existing options they cover.

Caplan explains that the free market issuance system, where patients can buy any cannabis product, partially complicates the problem. He suggests the system needs to be adjusted as insurance companies cannot be responsible for covering products that patients want to buy.

According to Jaeger, the barriers to cannabis coverage are numerous and complex, including legal and regulatory issues and changes in the dispensing system. As a result, the road to Medicare coverage is likely to be long and complicated, potentially many years before significant progress is made.

The road to cannabis legalization is long and requires extensive regulatory and policy reforms. To overcome the obstacles and establish a system that guarantees safe, legal, and cheap access to those who need medical marijuana most, lawmakers, regulators, healthcare professionals, and patients must work together.

Diploma

The issue of medical marijuana and Medicare coverage is complex, multifaceted, and riddled with legal and regulatory roadblocks. Despite the growing acceptance and legalization of medical marijuana in several states, the federal government’s designation of marijuana as a Schedule I drug has made it difficult for Medicare to cover medical marijuana costs.

Additionally, private insurers are unlikely to cover medical marijuana as long as it remains a Schedule I drug under federal law. The lack of FDA approval for the marketing of cannabis for medicinal purposes further complicates matters.

Despite these challenges, the healthcare industry is making strides to make medical marijuana accessible and affordable for patients who need it. As the stigma surrounding cannabis continues to dissipate and research into its medicinal properties continues, there is hope that medical marijuana will one day be covered by Medicare and private insurers.

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