Cannabis legalization is all the talk right now, as the medical efficacy of the drug is still a highly contested issue
However, insurers everywhere are now realizing that the D-day for medical cannabis coverage is now upon them.
Whether or not cannabis will save insurers money in the long term is not the question right now. Overall cost most certainly is. And insurers, for starters, have no wish to be on the front edge of this debate.
So what exactly is a “qualifying cannabis patient?” and why is this such an important question?
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According to the latest state data available in the United States, medical cannabis patients – those who self-identify or hold some kind of authorization card, has now surpassed 2 million people in the U.S. On a state-by-state basis, however, the numbers are even more revealing. In California, which has had a state program, albeit one that is still in development since 1996, 20 patients per thousand state residents, or .002 were medical cannabis users. In Colorado, there are 19.8 patients per thousand people.
Until, however, cannabis is removed from the Controlled Substances Act, patients must pay for their medical cannabis themselves. In fact, the only country right now that has integrated health insurance coverage into cannabis coverage is Israel. There patients must pay about $100 per month with coverage offset by a national insurance mandate.
The reality, however, is that getting cannabis coverage is often difficult. No matter where you are. And that is because the concept of a “cannabis patient” itself has not been defined. Much less accepted. Particularly by large companies who are required to underwrite this coverage.
This is not a new issue
The early 80’s were actually the first battleground on which this issue was fought. As AIDS patients were publicly reviled by a U.S. president, and medicinal cures were still unknown, the only medication that seemed to work to relieve symptoms was medical cannabis. For the next decade, in fact, it appeared that certain kinds of cannabinoid-based drugs were finally working their way into the “mainstream.”
By the passage of the Americans With Disabilities Act, however, the issue of being sick and treating your condition (whatever it was) with cannabis was off the table on a federal level. Congressional Republicans inserted language into the final bill that tried to rewrite the entire discussion on the medical use of cannabinoids. In fact, to this day, anyone who is sick enough to qualify for protection under the country’s strongest civil rights law – i.e. anyone who has a chronic condition – will lose civil rights protections in the U.S. under the same if they treat their condition with cannabis. In the U.S. this is even more of a dire proposition. If you lose your job, you will also lose your health insurance.
That is why, to date, there has been no court case of a medical cannabis user who has been fired from employment that has successfully challenged this difficult conundrum.
Further, it is also unlikely to change, until cannabis becomes something other than a Schedule I.
What About The Impact of Medical Use States – And Countries?
There is not a single insurer in the United States currently who is willing to touch this issue.
While cannabis drug policy in the United States is abysmal, thanks to lack of clear federal direction on what constitutes a “medical cannabis user,” the situation is not much better elsewhere. In Holland, for example, center of all things cannabis, certainly from the recreational side for the better part of two generations now, one would think the situation would be much clearer. However it appears that it is actually going backwards. As of late 2016, the largest insurer in this still mixed economy country, announced that they were ceasing to cover medical claims for cannabis. By the first quarter of 2017, the majority of the largest health insurers in the country decided to follow suit.
In Germany and Canada as of 2017, insurers are so reluctant to cover the drug – even with a federal mandate that they do so, that insurers in both countries are being sued by patients. In both countries, there is no disease mandate or patient guideline for cannabis prescription. While in Canada, patients appear to be willing to try to cover their monthly expenses directly, in Germany, there is no way they can. In Canada, a monthly prescription, even without health insurance coverage, is more or less affordable, about the price of a car payment. In Germany, with a federal mandate from the courts that patients must have access to cheap cannabis, plus now a federal law, insurers are basically insisting that they get sued before they agree to coverage – in what appears for now to be a case-by-case.
Ultimately, one would think that it is doctors and patients only who should be able to make the determination about who a legitimate cannabis patient is. However it is not that simple.
In every country where this has theoretically been true, the issue has been pushed back, repeatedly, to doctors and patients. And where they have taken matters into their own hands, even in places where medical is theoretically “legal” – they have been punished. At minimum, both doctors and patients have found themselves essentially threatened if not blackmailed, with covering the full costs of such prescriptions and therapies themselves.
So What Is a Legitimate Medical Marijuana Patient?
The real answer is, there is no clear definition of what a cannabis patient looks like or suffers from. Yet, where states or countries have attempted to define who a cannabis patient is, this has inevitably been broadened by clinical practice, legal challenges, or broadening understanding of the drug.
Broadly, you could be a patient if you suffer from MS, any kind of movement disorder, chronic pain, cancer, depression, PTSD, bowel disorder, immunodeficiency disease or diabetes. You could also be a patient if you are woman. Menstruation-related pain that is severe enough to intervene with daily life activities is an issue for at least 20% of all women. On top of that there is broad evidence that even CBD-based tinctures can help alleviate regular monthly discomfort.
If not already expensive
Between 10-20% of all adult populations, certainly in western countries, are classified as being “disabled” and of working age. If medical cannabis is routinely given to older people (over 65), however, this population explodes even further.
Should a cannabinoid medication be finally approved for something like weight loss, those figures will become almost meaningless.
As of now, total marijuana sales in the U.S. have outstripped what Americans spend on ice cream every year. And while a great deal of attention has been paid to the fact that such figures include “recreational” users – the reality is that many “rec” users are actually using the drug to treat an undiagnosed or untreated condition.
As cannabis becomes more mainstream, there is no reason why a large majority of adult populations will take some form of the drug, potentially even on a daily basis, as a health preventative of some kind – or even supplement. Who will pay for that, however, remains very much an open question.
For the conceivable future, in other words, a cannabis patient is not only someone who is sick – but further required to pay a huge amount of money for the only medication that reliably makes them feel better.
[Image credit- Wikimedia.Commons]