Your medical cannabis journey simplified: find partnered dispensaries, explore pricing options, earn rewards, and get answers to FAQs, all in one spot.
May 3, 2023 08:00 am ETEstimated Read Time: 4 Minutes
Due to cannabis’ federal Schedule I status, there are several limitations to who can provide cannabis and if insurance is able to step in and assist with the cost of seeing a provider and covering the cost of the cannabis. In states that allow medical marijuana programs, healthcare providers can’t prescribe medical marijuana, but healthcare providers can recommend it or make a referral to a state dispensary, or in some states, they are called pharmacies. A dispensary or pharmacy is a designated store where marijuana is sold outside the realm of traditional pharmaceuticals.
Even though cannabis is legal in 75% of the United States, most private and public insurance companies will not pay for medical marijuana recommendation use or marijuana products. Again, this all comes back to the fact that cannabis is federally illegal. Private insurance companies that operate on a national level must comply with federally-mandated coverage requirements. This means that most don’t want to risk entering the illegal muddy waters of medical cannabis, even if cannabis is legal in the state.
Medicaid, the federally operated health insurance organization, focuses on helping low-income individuals access affordable medication and healthcare but cannot assist patients in gaining access to medical cannabis because it is federally funded. A recent survey by MedicarePlans.com found that 2 in 3 Medicare beneficiaries said that Medicare should cover medical marijuana. This survey also found that 6 in 10 of those who support coverage said the reason is they believe cannabis can be effective when other treatments fall short.
Cannabis Covered by Insurance
There is one loophole to insurance covering the cost of medical marijuana. There are three FDA-approved prescription medications that contain cannabinoids. Healthcare providers can prescribe them, and Medicare may cover the cost. The FDA-approved cannabinoid-based medications are:
Epidiolex: This medication is approved to treat rare forms of epilepsy known as Lennox-Gastaut or Dravet syndromes.
Marinol and Syndros: These are brand names for dronabinol. They treat nausea and vomiting in people receiving chemotherapy for cancer. They’re also used to treat people with HIV/AIDS who have anorexia or significant weight loss.
Cesamet (Nabilone): This medication is also FDA-approved to treat nausea and vomiting in people receiving chemotherapy for cancer.
Changes are Coming
There is hope on the horizon. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources. Because Maedicaid has state involvement, there is some wiggle room on medical cannabis. The state of New York offers Medicaid services reimbursement through Medicaid for patient evaluation and certification, though not for products.
See If You Qualify For Medical Marijuana -Select Your State!
On the flip side, New Hampshire and New Mexico allow for the reimbursement of medical marijuana purchases on a state level. More recently, court cases in Pennsylvania and New Jersey have successfully argued for medical marijuana reimbursement in the case of workers’ compensation. Overall, on a national level, Medicaid is in the same boat as Medicare and will likely not assist with medical marijuana for several years or until the laws and regulations change.
Victory in Pennsylvania
Recently, a Pennsylvania appeals court ruled that the state’s medical marijuana law does not prohibit insurers from reimbursing injured workers for medical marijuana in cases where the drug is used to treat accepted work injuries.
In a worker’s compensation case filed by Paul Sheetz while working for Firestone Tire and Rubber, the Pennsylvania Commonwealth Court ruled that the state’s Workers’ Compensation Appeal Board made an error when it upheld a decision by Firestone Tire & Rubber to deny reimbursement for the cost of Paul Sheetz’s medical marijuana. Sheetz, who is now deceased, had been using medical marijuana to treat chronic pain from a 1977 work injury. He had used medical marijuana to taper off the decades of prescribed opioid use.
Ms. Kaufman, a Pennsylvania-based attorney who represented Sheetz, said the case means insurers must reimburse marijuana costs in cases where the treatment is deemed “reasonable and necessary” and that reimbursement would likely only come in serious or old injury cases where medical marijuana is the “primary treatment modality.” Firestone’s stance was that providing medical marijuana would violate federal law if forced to reimburse for medical marijuana. The court ruled reimbursement is not a federal crime because insurers are not prescribing the drug themselves.
Resources Other Than Insurance
To help offset the cost that insurance will not cover, several states and cities have programs that offer assistance with free or discounted medical marijuana patient ID cards, registration, and the cost of products. Until insurance companies are able to assist patients with costs, unfortunately, many will turn to opioids and benzodiazepines to treat pain and other issues. Insurance covering the cost of medical cannabis would be a step in the right direction of harm reduction against addictive pharmaceuticals covered by insurance.
Anna Schwartz completed her master's degree in public health with a focus on harm reduction. She is passionate about cannabis education and eliminating misinformation through data-driven research. Anna loves spending her free time in the great outdoors!
The ( govt. ) has never gave a shit
about humans consuming opiates
& becoming hooked. They say they care because the American believe
it. Just another form of population
reductions. Thanks for your time.
Have you ever consumed cannabis and gotten a little too high for your liking? Or have you ever needed to calm down a friend who consumed too much weed for their tolerance level? If so, we’ve got you covered. Although an overdose (taking more than what is medically recommended) of delta-9 tetrahydrocannabinol (THC) is not…
Cannabis tinctures are relatively new on the scene compared to the long, thousands-year-old history of the cannabis plant itself. It was first recognized for its medicinal use in European medicine in 1839, and by 1851, medicinal cannabis tinctures had made their way into a drug almanac known as the United States Pharmacopeia. Despite prohibition throughout…
When Piper Lindeen’s son Zach began showing medical issues at just three years old, no one suspected a rare, severe form of epilepsy. Doctors initially didn’t recognize his symptoms as seizures. Eventually, they diagnosed Zach with epilepsy—but by then, his condition had worsened from a few seizures a week to several each day. As it…
Though it may not be as widely discussed as other major health concerns like heart disease or cancer, liver disease is a common health condition that affects millions of people. According to the Centers for Disease Control and Prevention (CDC), there are currently 4.5 million adults who have been diagnosed with liver disease living in…
Over the years, Hollywood has had a mixed relationship with cannabis. Portrayals have run the gamut from weed as the devil’s lettuce, able to ruin your life and destroy your mind after just a single puff, to a beneficial, life-giving MacGuffin. Because American audiences have such wide-ranging attitudes towards weed— according to the Pew Research…
The statements made regarding cannabis products on this website have not been evaluated by the Food and Drug Administration (FDA). Cannabis is not an FDA-approved substance and is still illegal under federal law. The information provided on this website is intended for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. It is not intended as medical advice and should not be considered as a substitute for advice from a healthcare professional. We strongly recommend that you consult with a physician or other qualified healthcare provider before using any cannabis products. The use of any information provided on this website is solely at your own risk.