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posted 2019 Mar by
Patients have had to wait 17 years since medical cannabis became legalized in Canada, but insurance coverage is now available.
Last year, a major insurer began offering coverage, leading to other companies making changes to benefit plans and Health Care Spending Accounts (HCSA).
This article details the recent changes in medical cannabis coverage and the challenges some patients may face. Keep reading....
For years, insurance companies have been hesitant to cover medical cannabis, fearing higher costs than those associated with pharmaceuticals. In addition, since it’s a Schedule I drug in the USA, there’s less clinical research available compared to other health products.
However, as more patients start seeing cannabis as an option, more employers are requesting coverage from insurers. In 2018, Sun Life Financial became the first insurance company to offer medical cannabis coverage in Canada. Since then, other insurers have followed suit to fill the demands of employees and employers.
Some companies providing medical cannabis insurance include:
Sun Life Financial— Optional coverage under Extended Health Care (EHC).
Markers Insurance— Covered under BuyWell Care (partner company). Registration and approval are required.
Green Shield Canada— Coverage offered under EHC, requires approval based on specific medical conditions.
Manulife Financial— Offering optional coverage to those participating in Group Benefits plans and individual health insurance plans in Canada.
Great-West Life— Offering optional medical cannabis coverage to their Pay-Direct Drug Plans, which represent the vast majority of their drug plans, based on the nature of the patient's condition.
Desjardins Insurance— Coverage offered under supplementary health care coverage for group insurance plans. Prescription required.
Veterans Affairs Canada— Covers up to 3 grams or more per day ($8.50 per gram), if authorized. No limits on conditions.
Over time, it’s likely that more insurance companies will begin to cover medical cannabis. The details surrounding coverage (qualifying factors, maximums, out-of-pocket expenses, etc.) are also likely to change. For this reason, it’s a good idea to occasionally ask for updates from your provider if you’re using cannabis for medical purposes.
Medical cannabis coverage is still new in Canada, so it’s still not widely available. Since it doesn’t have a Health Canada-issued Drug Identification Number (DIN), cannabis isn’t typically covered under standard insurance plans but instead under extended plans and HCSAs.
One challenge patients may face is that they may not qualify if their condition isn’t listed with their insurance company. For example, Sun Life Financial covers cannabis if it’s used to treat cancer symptoms, multiple sclerosis, rheumatoid arthritis, HIV/AIDS or for patients under palliative care. That means if a patient suffers from migraines, anxiety or any other condition not listed, they may not be currently eligible.
With that being said, the list of conditions covered will likely grow over time as more studies become available. For example, Sun Life states the list will grow as regular reviews of clinical evidence are conducted.
Another issue could be the yearly maximum a patient is covered for, which varies based on what the employer chooses. However, the coverage could be as low as $1,500, which won’t go far if a patient is prescribed several grams per day.
You may be able to receive financial support if you have a medical cannabis prescription. People can find out if they have coverage by contacting their insurance benefits representative.
Questions to Ask:
Do I have medical cannabis coverage (extended plan coverage, HCSA coverage, etc.)?
If I Do Have Coverage:
Which conditions is it covered for?
What’s the yearly maximum per person?
What do I need to do before I’m approved? (Usually, an approval form will need to be filled out and assessed before claims are accepted.)
Is my medical cannabis paid for directly by the insurer or am I reimbursed? (Ex. Markers Insurance pays directly while Sun Life Financial requires you to pay out-of-pocket before reimbursement.)
If I Don’t Have Coverage:
If my condition isn’t covered, can the insurance company consider the medical necessity of cannabis in my specific situation? Which steps should I take?
Is the insurance company considering or planning on having coverage in the future? (Letting your employer know you want medical cannabis coverage could draw their attention to the growing demand and they may request it from the insurer as a result.)
Insurance coverage for medical cannabis in Canada isn’t as widely available as it is for pharmaceutical drugs. However, more providers are covering cannabis and that list is expected to grow. Patients may face some challenges such as which conditions qualify and how much medication their yearly maximum allows. Those details may change in the coming years as the body of research on marijuana’s therapeutic benefits grows. If you have an employer-sponsored benefit plan, you can contact your insurance benefits representative to see if you have medical cannabis coverage.
If you don’t have a medical cannabis prescription, you can get one from NamasteMD.com. You can then fill your prescription at Cannmart.com.