Will Medicare Ever Cover Medical Marijuana?

Medical marijuana is becoming increasingly popular among older adults as a treatment for various conditions. However, despite its growing acceptance, uncertain safety standards, conflicting laws, and complex regulations could delay Medicare coverage for years.

In April 2022, the Medicare Plans Patient Resource Center conducted a survey showing that 20% of Medicare beneficiaries presently use medical marijuana, and nearly a quarter has used it before. The study revealed that 66% of the respondents believe Medicare should cover the drug, underlining a growing interest in this substitute treatment among the elderly. Consequently, the uncertain status of medical marijuana's federal legalization and FDA approval has left Medicare coverage in doubt, leaving patients without this treatment option.

What are the Reasons for Providing Medicare Coverage for Medical Marijuana to Senior Citizens?

According to a study published in the journal Cannabis and Cannabinoid Research in April 2022, a significant proportion of patients (60%) visiting a major cannabis dispensary in New York were aged 50 or above. These patients relied on medical marijuana to alleviate various conditions, including cancer, severe or chronic pain, neuropathy, and Parkinson's disease.

Medical marijuana is also expensive, with edible products priced at around $5 per dose and plant buds ranging from $5 to $20 per gram, according to New York Cancer & Blood Specialists, a healthcare provider for patients with blood disorders and cancer. This translates to roughly $142 to $567 per ounce, making it an expensive treatment option. Unfortunately, even in states where medical marijuana is legal, patients may struggle to afford the prescription.

According to the executive director of Americans for Safe Access, Debbie Churgai, "medical cannabis isn't cheap ." Americans for Safe Access is a nonprofit organization promoting safe and lawful access to therapeutic cannabis and research. While some states may cover the cost of doctor visits or medical marijuana cards, insurance coverage for the products remains elusive.

What are the Federal-Level Obstacles Impeding Medical Marijuana Coverage?

The road to Medicare coverage for medical marijuana faces two significant hurdles. The first is the federal government's classification of marijuana as a Schedule I drug. The Drug Enforcement Administration defines Schedule I drugs as having "no current medical use and a high potential for abuse" in the United States. This presents a significant barrier to the drug's legalization and acceptance as a medical treatment.

According to Paul Armentano, the deputy director of the National Association for the Reform of Marijuana Laws (NORML), the federal government will not reimburse medical marijuana through a federal program since they classify it as an illegal substance.

The second obstacle stems from Medicare's requirement that the Food and Drug Administration deems a covered drug safe and effective. While the FDA has approved one cannabis-derived drug and three synthetic cannabis-related drugs for prescription use, the agency has yet to approve cannabis for medical treatment.

What is the Situation in States Where Medical Marijuana is Legal?

While medical marijuana remains illegal at the federal level, 37 states and Washington, D.C., have legalized its use for medical purposes. This raises the question of whether private insurers, such as those that offer Medicare Advantage plans, might choose to cover medical marijuana.

According to Kyle Jaeger, a senior editor and cannabis policy reporter at Marijuana Moment, it is unlikely that significant health insurers will cover medical marijuana. Like banks' reluctance to offer services to cannabis businesses, health insurers will probably refrain from covering cannabis as long as it remains a Schedule I drug under federal law.

In addition, private insurers typically follow the FDA's guidance when determining which drugs to cover. However, the FDA has recently declared that current regulatory pathways are inadequate for classifying CBD as a dietary supplement. Kyle Jaeger explains this situation can frustrate consumers seeking safe and reliable products.

What is the Threshold for Medical Marijuana Coverage?

According to Dr. Benjamin Caplan, founder, and chief medical officer of CED Clinic, which provides cannabis treatment services, insurers require more data on the medical use of marijuana. He notes that insurers need sufficient evidence to demonstrate that cannabis care produces results comparable to or better than those offered by existing options they cover.

Caplan explains that the free-market dispensary system, where patients can buy any cannabis product, partly complicates the issue. He suggests that the system needs to be adjusted since insurance companies cannot be responsible for covering any product that patients want to buy.

According to Jaeger, the obstacles in the way of cannabis coverage are numerous and complex, including legal and regulatory issues and changes to the dispensary system. As a result, the path to coverage for Medicare is likely to be a long and complicated one, with many years potentially passing before significant progress is made.

The path to cannabis legalization is long and involves major regulatory and policy reform. To overcome the obstacles and establish a system that assures those who need medical marijuana the most have safe, legal, and cheap access, lawmakers, regulators, healthcare professionals, and patients must work together.

Conclusion

The topic of medical marijuana and Medicare coverage is complex, multi-faceted, and riddled with legal and regulatory obstacles. Despite the growing acceptance and legalization of medical marijuana in several states, the federal government's classification of marijuana as a Schedule I drug has made it difficult for Medicare to cover the cost of medical marijuana.

Moreover, private insurers are unlikely to cover medical marijuana as long as it remains a Schedule I drug under federal law. The lack of FDA approval for the marketing of cannabis for medical treatment further complicates matters.

Despite these challenges, the healthcare industry is progressing toward making medical marijuana accessible and affordable for patients who need it. As the stigma around cannabis continues to fade and research on its medicinal properties continues to emerge, there is hope that one day, medical marijuana will be covered by Medicare and private insurers.