Even agencies with a more open stance on CBD, like the FDA, are helping to block insurance companies from covering it — with one notable exception, an anti-seizure medication called Epidiolex. Costing around $32,500 out of pocket for a year’s treatment, it was approved by the FDA in 2018, subsequently downgraded by the DEA to a Schedule 5 substance (the same non-restrictive category as prescription cough syrup), and is now covered without exception by insurers. However, it’s also blocking other CBD-derived medications from getting the same treatment, since its approval by the FDA means that any drug containing CBD would have to go through the same arduous, expensive process. So far, no other medication has been up for the challenge.
This has remained a popular view among many federal authorities. In 2018, when U.S. Health and Human Services Secretary Alex Azar was asked about medical marijuana as a pain relief alternative to opioids, he responded by saying there is “no such thing as medical marijuana.”
However, elsewhere in the paper, CBD users are given the possibility of an alternative: “The Agency is committed to science-based decision making when it comes to CBD, while also taking steps to consider if there are appropriate regulatory pathways for the lawful marketing of CBD, outside of the drug setting.”
Why Health Insurance Doesn’t Cover CBD Oil
“If it is undisputed that such drug has no currently accepted medical use in treatment in the United States and a lack of accepted safety for use under medical supervision, and it is further undisputed that the drug has at least some potential for abuse sufficient to warrant control under the Controlled Substances Act, the drug must remain in Schedule I.”
One of the main challenges that prevents CBD from being covered under insurance policies is the hostility of powerful government agencies to any cannabis-related product — a sentiment that insurance companies have noticed and respected.
Unfortunately, CBD is also quite expensive, so people will likely continue to ask this question until the answer becomes yes.
In its 2001 “Notice of denial of petition to reschedule marijuana,” the DEA emphasized that its main objection to the rescheduling of cannabis and its derivatives was not because of their potential for abuse, but rather for their lack of accepted use in medical treatment:
In this situation, patients who would benefit from using marijuana would be able to buy it over-the-counter like any other herbal remedy. As they are now, those patients would be highly motivated to find a way to pay for it themselves. Why would your health insurance want to set a precedent of paying for over-the-counter drugs or herbal remedies that you’re willing to pay for yourself?
Health insurers in the United States won’t pay for anything that’s technically illegal. Most health insurance policies include an illegal acts exclusion saying that health issues occurring due to or in association with your voluntary involvement in an illegal act are not covered (some states limit or prohibit these sort of exclusions ). Even though medical marijuana has most likely been legalized in the state where you live, it’s still classified by the federal government as a schedule I controlled substance as defined by the Controlled Substances Act. It’s still illegal to use marijuana in terms of federal law.
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Health Insurance Won’t Pay for Medical Marijuana as an Herbal Remedy
In summary, there’s more than one reason why your health plan won’t pay for medical marijuana. Even if marijuana were to be reclassified to a lower schedule or congressional action removed it from the list of controlled substances altogether, that wouldn’t be like waving a magic wand. Your health plan wouldn’t magically start paying for your medical marijuana a month or two later. Instead, it would be the beginning of a long, slow, process.
If you think it costs a lot now, wait until Pfizer, Merck, AstraZeneca or another big pharma company gains the exclusive right to bring marijuana to market in the United States.
Physicians who prescribe controlled substances must be registered with the Drug Enforcement Administration and have a DEA number. Prescribing a Schedule I drug, even in a state where medical marijuana has been legalized, would place a physician at risk of having his or her DEA registration revoked. Even if medical marijuana has been legalized in your state, as long as it’s considered a Schedule I drug by the federal government, prescribing it would put your physician at risk of losing his or her ability to prescribe even simple controlled substances like sleeping pills and cough syrup with codeine.
It would be highly unusual for a health plan to add a drug to its formulary if the drug hasn’t been FDA approved. Getting new drug approval from the FDA requires clinical studies to determine both the drug’s safety and that the drug is effective. Clinical studies are complicated and expensive to perform. So, when the FDA grants a new drug approval, it also grants a period of time in which the company given the new drug approval has exclusive rights to manufacture and sell the drug in the United States.
Current medical cannabis users are hopeful that private insurers will begin to recognize cannabis as medicine and cover the expenses. There is a large push to see cannabis covered the same way as any other prescribed medication, as well as better access for those who are on ODSP or a fixed income. There are advocacy groups & nonprofits that work with patients to discuss coverage with their employers and private insurers while showing supporting medical evidence of your prescription such as a doctor’s letter alongside the request. Currently, this is generally done on a case-by-case basis on whether or not the coverage will be approved.
Many Licensed Producers (LPs) also offer compassionate pricing to low-income individuals, seniors, and those on ODSP. Medical cannabis users should work with a patient educator who can help them determine if they qualify for compassionate pricing or other benefits. Patient educators are also able to recommend Licensed Providers who offer compassionate pricing, as not all LP’s offer this benefit. Apollo Cannabis Clinics employ patient educators to work with each individual after they receive a medical cannabis recommendation. Patient educators are committed to helping medical cannabis users understand what benefits certain Licensed Producers may offer. They also work to help individuals select LPs who carry the product they require.
More than 17 years after cannabis was first legalized in Canada for medical use, some insurers are just beginning to cover the cost of the medication. Slowly things are changing for the better as companies are being given the option from insurers to include medical cannabis. However, many plans limit coverage to just a handful of medical conditions that qualify and do not cover the cost of medical cannabis for most users.
But don’t fret – if your health insurance plan includes a Healthcare Spending Account (HCSA or HSA), you are likely able to claim medical cannabis under this category. Be sure to chec k the details of your insurance plan to see what is and is not covered. The Canada Revenue Agency lists medical cannabis as an eligible medical expense . Your proof of purchase (receipts) that include your prescription information, can be found online under your personal account with each Licensed Producer (LP) on their respective websites.
If you have any questions about your prescription, your apollo educator is here to assist you free of charge, 7 days a week.
As with most medical benefits there is a limit on the cost Veterans Affairs Canada will reimburse per gram of cannabis. A maximum rate of $8.50 per gram of cannabis is covered and medical users must pay the rest out of pocket. However, many reputable LPs will adjust the cost accordingly specifically for veterans.
Veterans Affairs Canada was the first Canadian institution to cover medical cannabis and has a revised coverage policy since November 22, 2016 through Medavie Blue Cross. The Veterans Affairs Canada website states “the health and well-being of Veterans is a top priority for the Government of Canada. This was the fundamental consideration in the development of VAC’s reimbursement policy for cannabis for medical purposes”.
One of the biggest benefits for medical cannabis patients and users is the ability to “write off” their medical cannabis medication on their yearly personal taxes as a medical expense . To be able to do so, the cannabis must have been purchased through a Licensed Producer, and have valid receipts of purchase.
If you need any paperwork filled out by your doctor, please contact Apollo and we will be happy to assist you*.