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With recreational cannabis set to be legalized later this year, some group benefits insurers still have issues about covering medical marijuana.
Although several insurers – such as Sun Life – have already jumped on the medical cannabis bandwagon, others have adopted a more cautious approach to the treatment.
Cyd Courchesne, chief medical officer at Veterans Affairs Canada, which has offered coverage for medical cannabis since 2008, explained that the hesitation could be because those insurers have seen what has happened to some agencies in and outside of Canada that have provided the coverage and saw their costs and usage reach exorbitant levels.
“If I was working for any other company, and I was their medical director, I would say do not reimburse,” Courchesne told Global News.
He added that the medical community is still trying to understand more about the effects of cannabis, so a number of group insurers naturally remain skeptical.
“We do not have enough information right now.”
The rising cost of covering medical cannabis
In 2008, Veterans Affairs Canada initially covered up to 10 grams of medical cannabis per day for members, without limits on price or medical condition. But after costs spiked to $63.7 million in the year ended March 2017 from $19,088 in fiscal 2009, the insurer limited coverage to three grams a day at $8.50 a gram. In the year ended March 2018, the insurance agency posted total reimbursements of $51 million, reflecting a noticeable reduction after the coverage was restricted.
According to Courchesne, Veterans Affairs Canada imposed limits to give patients a “more appropriate dose,” but costs were also considered.
Under Canadian law, patients are allowed to purchase medical cannabis with money from employer-financed healthcare spending accounts. The insurance companies providing these group benefits, however, are free to impose any exclusions on coverage – including cannabis.
Lack of evidence regarding cannabis’s efficacy as treatment
Courchesne noted that current research is inconclusive on whether marijuana effectively reduces pharmaceutical drug use when both are incorporated into treatment.
Even the Canadian Medical Association has warned its members to proceed with caution when prescribing marijuana treatments to patients, citing the lack of evidence that supports the medication. The association’s vice president for medical professionalism, Jeff Blackmer, has shared that while he authorized medical marijuana for two of his patients (after all other treatment methods had been exhausted), he has seen little improvement in them.
Lack of scrutiny over prescriptions
Doctors and other healthcare organizations that prescribe marijuana do not scrutinize the medical need of their patients enough, Courchesne believes.
Groups such as OneOunce.com and the Green Doctor Network directly charge patients fees (from $150 to $295) for consultations that guarantee marijuana prescriptions. In Green Doctor Network’s case, the organization requires no documentation or referral, only requiring patients to fill out an online application form, while the former conducts both in-person and Skype-based consultations, according to the publication.
In a statement, Federation of Medical Regulatory Authorities of Canada CEO Fleur-Ange Lefebvre said that the Federation expects healthcare professionals to authorize cannabis medications only for patients with whom they have an existing medical relationship and after in-person consultations.
