Why Insurance Does Not Cover Your Medical Marijuana


Although recreational marijuana is spreading, being legalized in four states in the last three years, medical marijuana has an even wider presence in the United States. It is legal in 23 states and Washington, D.C., and will be on upcoming ballots in others.

Medical needs are prevalent and healthcare is anything but cheap in the United States. Being able to afford medication has always been a concern of the sick, and especially the poor and sick. As marijuana becomes the answer for more health problems, the same question applies, “How can I afford it?”

Some dispensaries charge anywhere from $25 to $60 for an eighth, which racks up quickly for those that utilize marijuana to manage chronic pain. These patients might spend more than $1,000 a month.

Medical marijuana is prescribed for a variety of conditions and has been proven effective in their treatment, leading to its validity in almost half of the United States. Its potential use in the treatment of diabetes might be one of the more current developments, as was noted in a recent study. Not only did subjects with a history of cannabis use have a 30 percent less likely chance of developing diabetes, but current users were shown to have insulin levels that were 16 percent lower than non-users.

A topic that always goes hand in hand with diabetes is that of obesity, another hot button topic for the Untied States as a whole. As noted by multiple sources, marijuana may actually help combat obesity.

Medical marijuana has also been shown helpful in treating a variety of health issues, including autoimmune diseases such as HIV/AIDS and multiple sclerosis, inflammation, pain, seizures and mental disorders. As this is the case, many patients wonder why it is not covered by health insurance.

The major obstacle resides in the way the federal government classifies marijuana—it is a Schedule I controlled substance. This definition, according to the Drug Enforcement Administration, states that marijuana has “no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.”

Currently, there are only two FDA-approved medications that are cannabinoid-related, and both are in pill form. These drugs are both synthetic—one is a synthetic version of a substance in marijuana and the other mimics marijuana compounds but this drug is not actually present in the plant itself. In pill form, doses can be regulated, whereas this is more difficult to do when smoking the plant.

One of the major blocks in the way of insurance coverage is that the FDA requires human clinical trials that are performed on “hundreds to thousands” of participants. There have simply not been enough trials in order to grant validity to marijuana. In order to perform these trials, there are numerous bureaucratic hoops that must be jumped through—an application must be submitted to the FDA, which can then be reviewed by the National Institute on Drug Abuse, or NIDA, who then will supply the federally sanctioned marijuana, of which there is only one source. After all of this, a secure facility must be used and the trials must be conducted and monitored.

The last step for insurance coverage, if the FDA were ever to approve the drug, would fall to the hands of the actual insurance companies. Because employers decide what will be covered on their employees’ plans, it is entirely possible that the company will opt out of paying for this specific treatment.

This is not necessarily the case everywhere, as is demonstrated by Canada. In July 2015, as previously reported in MJINews, Health Canada changed medical marijuana regulations to allow the sale of the substance in both oils and plants. Because it will be available in a gel cap form, it will begin to be viewed on a level playing field with other medicines. Khurram Malik, an analyst at Jacob Securities Inc., told The Canadian Press, “You’re going to see insurance companies slowly start to creep into the sector.” Currently, it is rare for companies to cover marijuana, but approval has been given on a piecemeal basis at the request of an employer.

The 2016 presidential election could prove pivotal in the road to legitimizing cannabis for medicinal use. As popular opinion shifts and more medical evidence is collected, the United States edges closer to a possible change in the federal definition of marijuana. Time will tell, but medicinal marijuana on a larger scale is not out of the realm of possibility.

Josh Browning is a writer and editor based in Washington and has a background working in the technology, education and creative writing fields. He earned his MA from Western Washington University and his BSS from Ohio University.

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