Will Insurers Begin Covering Medical Marijuana?

Medical marijuana has a long history of being denied coverage by insurance companies. Up to now most insurance companies refuse to cover cannabinoid treatments, typically citing federal regulations as the main reason to decline medical marijuana coverage. This is especially true in the United States where cannabis is a Schedule I controlled substance under the Controlled Substances Act (CSA) with "no perceived medicinal value". In New Mexico, an employee hurt on the job was denied medical marijuana coverage under his worker's compensation insurance and his suit to force the coverage failed. Beside the ruling in New Mexico, lower courts in Michigan, Maine, Massachusetts and Connecticut have given similar verdicts to workplace insurers.

However, a recent Canadian Human Rights decision and a New Jersey administrative law court decision may open the door for a new chapter in the medical marijuana story.

The human rights board in Nova Scotia made a landmark decision to require a medical marijuana patient's employee insurance plan to cover the cost of his cannabis treatments. Gordon Skinner has been using medical marijuana for the treatment of an on-the-job injury that has kept him from work for the past 6 years. He argued that he was being discriminated against due to his use of medical marijuana.

The board agreed with Skinner, citing the requirement of a doctor's prescription to obtain the needed cannabis. By denying his claim for coverage for a doctor's prescription, the board claimed that the insurance company's actions amounted to a prima-facie case of discrimination," the ruling states. "The discrimination was non-direct and unintentional." The board went on to state that the insurance plan contravened the province's Human Rights Act, and must now cover Skinner's medical-marijuana expenses "up to and including the full amount of his most recent prescription."

This opens up the possibility of patients in other provinces to appeal insurance denials under their local human rights authorities, says Jonathan Zaid of the Canadians for Fair Access to Medical Marijuana (CFAMM).

Beyond the Nova Scotian board, Canadian Insurers Sun Life and BMO recently changed their policies to differentiate between tobacco and cannabis smokers, dropping the coverage fees for cannabis-only smokers considerably as based on the known scientific evidence marking yet another advancement of medical marijuana in the insurance industry.

In the United States, a new, similar story is beginning to unfold. A New Jersey man won a case against a workmen's compensation insurer. In December 2016, Judge Ingrid French decided in favor of Andrew Watson of Egg Harbor Township. In her decision, Judge French stated, "While the Court is sensitive to the controversy surrounding the medicinal use of marijuana, whether or not it should be prescribed for a patient in a state where it is legal to prescribe it, is a medical decision that is within the boundaries of the laws in the State of New Jersey. In this case, there is no dispute that all of the credible evidence presented confirms that this Petitioner is an appropriate candidate for New Jersey's medical marijuana program." The insurer will be required to reimburse Watson for the cost of his treatments in the past as well as "any medical treatments using cannabis in the future".

What could this mean for medical marijuana patients and insurance companies in the United States?

Currently, 28 states plus the District of Columbia have medical marijuana programs. There are approximately 1.2 million medical marijuana patients who purchase medical marijuana in those states and many have difficulties paying for their cannabinoid treatments, some of which can be up to $300/week for intensive cancer treatments. Patients need to cover those expenses out of pocket and many low-income patients are left suffering without a way to pay for those costs.

The cost of an initial chemotherapy treatment can cost upwards of $7,000 and an eight week regime could cost up to $30-40,000. At $300/week, the cost of cannabis treatments is only $2,400-$3,000 over an eight week period. From the perspective of the insurance company, they should be encouraging patients to use cannabis.

The two cases now give precedent for attorneys who are fighting insurance company denials for medical marijuana treatments. We may end up seeing more cases of judges favoring for the patient in states with legal medical marijuana programs.

Do you use medical marijuana and wish your insurance company covered it? Leave us a comment and tell us what you think.

This article was originally posted on the GreenSea Distribution blog.