New Mexico lawsuit seeks medical cannabis insurance coverage

A New Mexico cannabis company and a group of six medical marijuana patients have filed a class action lawsuit seeking medical cannabis insurance. The lawsuit was filed in Albuquerque District Court on Friday, with plaintiffs arguing that medical cannabis should be covered because it is a valid behavioral health service.

Plaintiffs in the lawsuit are New Mexico Top Organics-Ultra Health and six medical cannabis patients, including Senator Jacob Candelaria. Documents filed in the case indicate that Candelaria has been a medical cannabis patient since 2019, when his doctor recommended he use medical cannabis to treat post-traumatic stress disorder after antidepressant medications had failed to bring relief. Candelaria pays between $500 and $1,000 a month out of pocket for its medications because its insurer, Blue Cross and Blue Shield of New Mexico, does not cover medical cannabis for its customers, according to the lawsuit.

In the lawsuit, plaintiffs in this case are seeking “redress for themselves and for any other similarly situated behaviorally or mentally ill person who was unlawfully subjected to payment of the entire cost of medically necessary cannabis in violation of state law.”

The lawsuit identifies Blue Cross and Blue Shield of New Mexico, True Health New Mexico, Cigna Health and Life Insurance Co., Molina Healthcare of New Mexico, Presbyterian Health Plan, Presbyterian Insurance Co. and Western Sky Community Care as defendants in the lawsuit called . The lawsuit builds on legislation passed last year, Senate Bill 317, that requires insurers to pay 100% of the cost of behavioral health services, including treatments prescribed for behavioral health problems. The measure was passed in April 2021 and came into force on January 1 of this year.

“The idea of ​​health insurance companies paying for medical cannabis might seem like an impossible dream, but all the basic elements are already in place,” Duke Rodriguez, Ultra Health’s president and CEO, said in a statement to the Albuquerque Journal on Monday. “The behavioral health care revolution in New Mexico will take a few small steps, not a giant leap.”

February letter sought medical cannabis coverage in New Mexico

In February, Ultra Health sent a letter to insurers and the Office of the Superintendent of Insurance to request coverage for medical cannabis recommended for treating behavioral disorders. The letter included data provided by the New Mexico Department of Health in April showing that of the 134,307 patients enrolled in the state’s medical cannabis program, 73,000 were diagnosed with PTSD.

“Ultra Health acknowledges that the idea of ​​health insurers paying for medicinal cannabis may seem novel at first,” the company wrote in its letter to Presbyterian Healthcare Services.

“However,” the letter continues, “it is actually a rational, reasonable notion when viewed in light of other New Mexico laws. In New Mexico, workers’ compensation insurers already have to pay for medical cannabis, and in New Mexico, medical cannabis is already treated the same as traditional prescription drugs. The fact that health insurance companies should and will pay for medical cannabis is not revolutionary at this point. It’s the next logical step, and it’s a small step, not a giant leap.”

True Health New Mexico and Blue Cross and Blue Shield of New Mexico declined to comment on the case, according to media reports. New Mexico’s Molina Healthcare, Western Sky Community Care and Cigna did not immediately respond to requests for comment. Presbyterian Health Plan and Presbyterian Insurance Co., which are overseen by the same management team, also declined to comment on the case but did provide a statement on the companies’ policies.

“Presbyterian Health Plan is committed to ensuring New Mexicans have access to the behavioral health services they need,” said spokeswoman Melanie Mozes. “The lawsuit has not yet been served on us and we reserve the right to comment on the appropriate place of jurisdiction.”

Rodriquez said the lawsuit was filed after insurers and state regulators failed to respond to the letter sent in February. He also noted that other patients affected by insurers’ failure to cover medical cannabis prescribed for behavioral therapy are welcome to join the lawsuit.

“More patients are being identified who have been harmed by insurers who are not lawfully complying with the legal obligation to eliminate any co-payment associated with behavioral health services,” Rodriguez said. “The insurers did not act in good faith.”

In an interview, Candelaria said that medicinal cannabis has helped him deal with PTSD and has had a positive impact on his life. He added that he has joined legal action to help all “New Mexicans who are struggling to pay for their healthcare.”

“Senate Bill 317 was transformative,” Candelaria said. “That suit, you know, becomes necessary to actually bring about that transformation.”