It’s tempting to believe that if you reside in a place where medical marijuana use is allowed, which includes 37 states and DC as of late 2021, your health insurance will cover it as with other medications prescribed by your doctor. You would be mistaken, though, because even in jurisdictions where the use of medical marijuana is permitted, health insurance will not cover its costs.
Medical marijuana is not covered by health insurance even though a variety of other medications are, many of which may be more harmful and abuse-prone.
1. Changing The DEA and Schedule 1 Classification for Marijuana would not allow Cannabis in Health Care Coverage.
Anything technically illegal won’t be covered by health insurance in the US. The majority of health insurance policies have an exclusion for illegal conduct that stipulates that health problems that arise as a result of or in connection with your voluntarily participating in an illegal act are not covered. However, some states limit or prohibit exclusions like these.
Despite the fact that your state has probably authorized medical marijuana, the federal government still considers it to be a schedule I restricted substance under the Controlled Substances Act.
The Schedule I classification of marijuana raises additional concerns besides the exclusion clauses for unlawful conduct in health insurance policies. Healthcare professionals cannot prescribe Schedule I controlled narcotics the same way they may other medications.
The Drug Enforcement Administration requires medical professionals who prescribe controlled medications to register with them and obtain a DEA number. Even in states where medicinal marijuana is permitted, prescribing a Schedule I medicine could suspend a healthcare provider’s DEA certification.
2. Putting Cannabis on the Drug Formulary would possibly allow Doctors to prescribe it.
Because of this, few medical professionals recommend medical marijuana. Healthcare professionals advocate medicinal marijuana rather than prescribing it in states where its use is permitted (Cigna describes how a doctor can write a “certificate” that the patient can take to a medical marijuana dispensary. If medical marijuana is not covered by health insurance because it is not included in the drug formulary
Your health insurance company undoubtedly wouldn’t cover your medicinal marijuana even if the United States changed marijuana from a schedule I drug to a schedule II or III substance, legalizing its prescription nationwide and decriminalizing its use for medical purposes. Similarly, even if Congress were to completely remove marijuana from the list of prohibited narcotics, your health insurance probably wouldn’t pay for it, even if your doctor approved them.
A drug formulary, or a list of pharmaceuticals that the health plan covers for its members, is a feature of any health plan. Before marijuana would be covered by your health insurance, your health plan’s pharmacy and therapeutics committee would have to add it to its list of approved medications.
3. Getting FDA approval would drastically increase the price of Cannabis.
A health plan adding a medicine to its formulary without FDA approval would be extremely uncommon. Clinical studies must establish the drug’s safety and efficacy before the FDA approves a new drug. However, clinical research is difficult and expensive to carry out. So, when the FDA approves a new drug, it also approves a time frame during which the firm receiving the permission has the only right to produce and market the drug in the United States.
Wait until Merck, Pfizer, AstraZeneca, or another big pharmaceutical corporation obtains the sole right to market marijuana in the United States if you think it is expensive now.
4. Synthetic THC and other drugs getting approval.
Your health insurance won’t cover medical marijuana if it doesn’t receive FDA approval and isn’t listed on your health plan’s prescription formulary. Big pharma, exclusive marketing rights, and astronomical prices would almost certainly be involved in the process of getting marijuana legalized. Further information on this can be found in a marijuana paper the FDA produced.
Yet, the FDA has recently authorized Syndros, Cesamet, and Marinol. All three of them include synthetic THC. Epidiolex, an oral CBD medication for treating seizures linked to two types of epilepsy, received FDA approval in 2018. While not the same as cannabis, these medications can be given just like any other FDA-approved prescription and are frequently covered by health insurance policies.
The Cannabis Paradox
Cannabis might be made accessible without a prescription if its classification was changed so that it was never considered a controlled substance in the first place. Yet even then, medical marijuana wouldn’t be covered by health insurance. However, life insurance rates may be affected by Cannabis use. Therefore, check with Marcan to find out more.
When a drug is no longer required to be prescribed, it is taken off the drug formularies of health plans, and you are expected to pay for it out of pocket. Do you currently receive reimbursement from health insurance for over-the-counter drugs like Tylenol? most don’t. Does it include natural medicines like echinacea and St. John’s wort? Not likely.
Who would benefit if health insurance covered medical marijuana?
Those who might benefit from marijuana use in this scenario would purchase it over the counter like any other herbal medication. Given their circumstances, such patients would be strongly motivated to find a method to pay for it themselves. Why would your health insurance want to establish a precedent by paying for herbal cures or over-the-counter medications you are willing to pay for yourself?
Will anything change?
It wouldn’t be like waving a magic wand if marijuana were to be shifted to a lesser schedule or completely removed from the list of restricted substances by congressional action. Your medical marijuana wouldn’t suddenly be covered by your health plan a month or two later. Instead, it would mark the start of a protracted, tedious process.
Your health plan might ultimately cover marijuana as a prescription drug on its drug formulary if the procedure results in it being an FDA-approved drug. Yet that wouldn’t happen for months. In fact, it wouldn’t happen for years. Even more surprisingly, it is quite doubtful that your health insurance would cover marijuana if it turned out to be a herbal medicine that did not need FDA approval.