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Does Medicare Cover Medical Cannabis/Marijuana?


Is it just me, or does it feel like the 1960s again? It seems like everytime I turn on the news, there’s stories about marijuana. Whether they’re discussing the growing number of seniors openly using marijuana or the changes in federal and state laws, marijuana is a topic many people are chatting about.

The issue of medical marijuana continues to be a controversial one. Yet, more and more seniors are curious to learn about the benefits and drawbacks to this not-so-new drug.

Nearly 23 states in the U.S. have legalized medical cannabis (one of the more scientific names for marijuana, if you will)  along with Washington D.C. Countless patients suffering from chronic pain, cancer, seizures, anxiety, depression and other conditions are now able to seek treatment using cannabidiol (CBD) and tetrahydrocannabinol (THC), the active ingredients in the cannabis plant.

With prescription drug prices on the rise, the recent legalization has many asking: does insurance cover purchases of marijuana for medical use? How about Medicare? In this blog post we’ll discuss Medicare specifically and the coverages allowed for prescriptions such as marijuana across the United States.

Medicare & Marijuana

 

As of the writing of this publication, medicinal marijuana is not covered by insurance carriers in the U.S. which includes Medicare, Medicare Supplements, and Medicare Advantage plans. Medicinal cannabis is also not covered by Medicaid, private plans, group plans, the Veterans Administration (VA) or Obamacare plans.

Cannabis users today receive many mixed signals about the acceptability of this form of medication. Today, marijuana use is on the rise but is still stigmatized and not widely accepted – legally or otherwise.

Why Medicinal Marijuana Isn’t Covered by Insurance

So what’s all the fuss about really if it’s legal in specific states?

Marijuana is still a Schedule I controlled substance under the Federal Controlled Substances Act. It was recently reclassified as a Schedule I, even though many researchers and scientists advocated for a lower classification for the drug.  

Schedule I drugs are defined by the United States Drug Enforcement Agency as, “substances with no currently accepted medical use and a high potential for abuse.” Drug listed as Schedule I are barred from receiving federal or state research grants to study the drug’s medical efficacy, even though there has been a call for increased medicinal marijuana research. Understandably, many private research companies and universities are hesitant to do research and clinical trials on a substance considered so dangerous by the federal government.

Due to the restrictive nature of the drug’s scheduling, research studies on marijuana vary greatly. A simple internet search about medicinal cannabis can make your head spin! Some studies rave about the benefits marijuana has for people receiving chemotherapy, for example, while other studies warn that the chemicals in cannabis increase the risk of cancer. Until the restrictions are lifted on researching marijuana, it will remain largely-understudied.

As a Schedule I drug,  marijuana is in the same category as some of the most dangerous drugs like heroin, LSD and even Mescaline (Peyote). This presents a problem in the eyes of lawmakers contributing to health insurance not covering it widely. Again, with a lack of reliable or consistent research, lawmakers are hesitant to allow insurance companies to cover the drug.

Drugs that are covered by insurance are usually required to pass Food and Drug Administration (FDA) approval. This is incredibly hard to do in the case of marijuana, due to its Schedule I status.  Furthermore, the FDA approval process for many medicines can take years! Seniors already self-medicating with medicinal marijuana argue they should not have to wait that long for approval of a plant, while anti-drug advocates feel that insurance coverage or marijuana will lead to increased use.

Conflicting laws don’t help either. At the Federal level marijuana is still illegal and large insurance companies that operate in several states don’t want to risk prosecution. Employees of most large companies, even in states where it is decriminalized, are not allowed to partake in the federally illegal substance and if they test positive, they could face termination.

Even in states where marijuana is legal for use by adults – whether it be legal of medicinal purposes only, or fully decriminalized for recreational purposes – insurance companies have chosen to not provide coverage of the drug. Some states have laws on the books that prevent coverage, while in other states, the insurance companies have made the decision to not provide coverage for a variety of reasons. Some people feel that insurance should have to cover medicinal marijuana as prescribed by a licensed physician, but most states have laws allowing for pharmacists to refuse to fill any prescription that is not in line with their moral or religious beliefs. Until Federal legalization is an actuality, insurance companies will likely resist covering medicinal marijuana prescriptions.

Reclassifying Marijuana

To most, the classification of marijuana just doesn’t make sense. The American Medical Association has called for change that makes it easier to research and conduct clinical trials. While a majority of existing research does show the positive effects marijuana can have, extensive testing is still required to further press the issue of classification.

As mentioned before, some scientists won’t study the drug because of its classification as the most dangerous type of substance. But lawmakers won’t consider changing the marijuana classification until research is compiled. As you can see, this is a perfect example of “what came first, the chicken or the egg?”

It’s not likely that reclassifying will happen anytime soon. According to The Brookings Institution, “the politics surrounding administration rescheduling are unfavorable” when it comes to marijuana. Congress has the power to reschedule marijuana through new legislation or through amendments to the Controlled Substances Act. This summer, they chose not to act and marijuana remains a Schedule I drug.

The Cost of Medical Marijuana

The cost of medicinal cannabis is largely dependant on the strength of the dose, the frequency of the dose, and the way it’s administered. Similar to traditional pharmaceuticals, medical marijuana’s costs, if it were legalized federally – could also fluctuate based on the manufacturer and seller of the medication.

In the states where marijuana use is allowed by adults, prices vary largely based on the method of administration. Many seniors, especially those who have respiratory issues, opt for edible types of medicinal pot, such as candies, lozenges, and cookies. Others prefer to use marijuana in the more “natural” sense by smoking it through an apparatus.

Of course, the out of pocket costs for medicinal marijuana also varies based on location. Since insurance companies do not cover prescribed cannabis, users are forced to pay full price for the medication, which they pick up from legally licensed dispensaries (similar to a pharmacy, but only they only sell marijuana).

Depending on the state in which you reside, some dispensaries offer discounts for low-income patients who would like to use approved medicinal marijuana with a prescription from a Doctor. Some states also offer discounts for low-income individuals on the cost to receive a medicinal marijuana card – which can run as much as $300-$500 in some states.

Without discounts, marijuana can cost some patients as much as $1,000 a month. This can be a large burden on a fixed-income like many individuals with Medicare. With Medicare Part D plans you can save on prescriptions, but until marijuana is rescheduled, Part D plans will not cover marijuana.

Medicare & You

medicare-and-youMany seniors have mixed feelings on medicinal marijuana. Some of you may remember the film “Reefer Madness” and the horror stories about marijuana use it chronicled. Others, especially Baby Boomers, feel that marijuana may the the “wonder drug” we’ve all been waiting for.

“I’ve read all about pot addition and can’t imagine why Medicare would allow for such a dangerous drug to be used!” shared Irma. “I’ve never smoked a day in my life and can’t imagine my doctor encouraging it now at my age.”

However, Irma’s friend, Sue, has a different opinion: “If marijuana can help a sick person feel better, I’m all for it. It has to be better than the harsh chemicals with all the side effects we take now. Just look at my medicine cabinet and tell me that all of those drugs are safe!”

Regardless of your feelings on whether or not marijuana should be decriminalized, it is surely going to remain a topic discussed on the evening news. As more and more adults – especially seniors – admit to using marijuana and as more health care advocates share the drug’s positive effects, the more likely it is that insurance companies and legislators will take notice. If it ever becomes a covered prescription by Medicare Part D, it will be another factor to consider when choosing your Medicare plan.

Click here to read more Frequently Asked Questions about Medicare, including other things Medicare doesn’t cover.

Selecting the right Medicare plan that will cover your prescription needs is an important task, and one you shouldn’t take lightly! Give our agents a call at 1-844-305-6169 and we’ll walk you through the best Medicare supplement plan that will help you save on your prescription drug costs today.

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