HARRISBURG — Patients using medical marijuana get no help covering the cost because insurance companies won’t cover the costs of the drug.
Health Secretary Dr. Rachel Levine said that the private insurers are following the lead of the Medicaid and Medicare programs both of which refuse to pay for medical marijuana due to the federal ban on the use of the drug as a medicine.
With patients bearing the burden of the cost of the treatment, the state is moving to set up a program to help low-income individuals pay for their medical marijuana, Levine said.
“Because medical marijuana is a Schedule I drug, Medicare and Medicaid won’t cover it,” Levine said. “So patients pay out of pocket.”
Dr. Yi Yan Hong, a pain management specialist in Johnstown, says his patients pay from $60 to $200 a month for legal cannabis.
The insurance industry is hamstrung by the same conflict between federal and state law that’s preventing the banking industry from widely providing service to the marijuana industry, said Sam Marshall, president and CEO of the Insurance Federation of Pennsylvania.
“We expect change at the federal level will and should be coming, but who knows when. Our hope is that medical marijuana becomes a safer, more effective and more affordable means of pain management and other evidence-based uses, and we’ll cover that,” Marshall said. “But coverage means payment, and that seems to necessitate a change in the federal law for businesses like ours, that can’t be cash-based.”
Levine said the only exception she could think of in which there is an effort to get insurance to cover some of the cost is that some states are seeking to have medical marijuana covered through workers’ compensation programs.
Asked to clarify Levine’s comments, Health Department spokesman Nate Wardle said the secretary was only speaking “anecdotally” but didn’t have specific information about states requiring workers’ compensation to cover medical marijuana.
An analysis by the Murray Insurance group in Lancaster identified five states that mandate that medical marijuana be covered by workers’ compensation. Those are: Connecticut, Maine, Minnesota, New Jersey and New Mexico. New Mexico was first to do so, following a 2014 case in which a judge ruled that the state’s workers compensation law should include medical marijuana as a form of treatment.
The insurance company’s analysis noted that while workers’ compensation elsewhere doesn’t cover medical marijuana, it’s possible it will become more common, particularly as physicians seek alternatives to opioids to treat chronic pain.
“In the future though, as more research is conducted as to the efficacy of medical marijuana, it may become a very real treatment protocol,” according to the Murray Insurance analysis.
Marshall said that in states where workers’ compensation is covering medical marijuana, the insurance companies are not directly paying the medical marijuana dispensaries. Instead, it appears that the patients are paying cash to get the drug and then getting reimbursed by the insurance company, he said.
He added though that Pennsylvania’s medical marijuana law seems to address this issue head-on and bars anyone from forcing insurance companies to cover the cost of medical marijuana.
The law indicates: “‘it should not be ‘construed to require an insurer or a health plan … to provide coverage for medical marijuana.’ That would seem to override PA’s workers’ comp law the insurers cover ‘reasonable and necessary’ medical expenses,” Marshall said.
The insurance industry will also resist efforts to get medical marijuana covered unless there is better evidence that the drug is effective and what conditions it’s effective for, Marshall said.
“Nobody should want this to turn into the same abuses we see now in other pain medications, which have been both expensive for employers and dangerous for injured workers,” he said..
The issue of getting patients help to pay for medical marijuana is important because while the cost of medical marijuana has come down as the state’s program has matured, “it’s still too expensive,” Levine said.
Levine said the state’s move to allow dry leaf marijuana as a form of medicine helped lower the cost of marijuana. And as more growers and dispensaries open, the increased competition should drive the price down further.
To help address the problem, the Department of Health will roll out a program next year to help low-income individuals buy medical marijuana.
The concept was tucked in Act 16, the state law legalizing medical marijuana, Wardle said.
The law states that a portion of the tax revenue generated by the medical marijuana program will be set aside to help those “who demonstrate financial hardship or need” to purchase.
Levine said the program can’t launch until next year because the regulations need to be completed and approved.
Other states have taken steps to encourage dispensaries to offer discounts to poor patients, said Karen O’Keefe, director of state policies for the Marijuana Policy Project, a Washington, D.C.,-based organization that lobbies for marijuana reforms.
Delaware, for instance, made one of the factors considered when permit applicants were being judged whether the dispensary would offer discounts to people receiving Medicaid or Social Security assistance, she said. North Dakota’s law is similar, she said.
O’Keefe said she’s not aware of any other state current using tax dollars to help patients pay for the drug.
“I believe, however, that PA will be the first where the state itself may provide assistance for low-income patients to purchase medical cannabis,” she said.