A lack of medical consensus makes drug plan coverage of medical marijuana very difficult

Medical marijuana may well be here to stay, but there are still far more questions than answers when it comes to actually managing it as a mainstream pharmaceutical option for Canadians.

Of particular interest to people in the benefits management business, of course, is the issue of who pays for it, and whether drug plans should look at covering it – and, if so for which conditions, in what amounts and for how long. That’s where it gets complicated, contradictory and, inevitably, controversial.

The first big issue is that marijuana, in the form of dried plant material to be smoked by the patient, does not have a DIN, or drug information number, from Health Canada. This is not just a technicality or bureaucratic delay. It reflects the fact that marijuana has not yet been able to meet the standards set out in the Food and Drugs Act.

In order to be approved in Canada, every new drug has to undergo a very rigorous process of testing to prove, first, that it is safe for patients to use as prescribed; second, that it is effective for the indicated purpose; and third, that the product is consistent in dosage and produced under strict quality control.

These standards apply to all prescription drugs – and marijuana has not really met any of them.

A second issue is the fact that there is no consensus in the medical and scientific community about what conditions can be treated or managed by smoking marijuana.

The concept of marijuana as medicine first gained credibility decades ago when evidence started to emerge that it was helpful in stimulating the appetite of patients receiving chemotherapy for cancer. Then it was shown that it could benefit patients suffering from glaucoma – a chronic eye disease that can lead to blindness. Currently, some physicians are also recommending marijuana for chronic pain, seizures and even dementia.

South of the border, where many individual states allow medical marijuana, it is approved for a very long and varied list of conditions, depending on the state. Cancer, glaucoma, chronic pain, HIV/AIDS and seizure disorders make it onto most lists, but many other conditions are included by some states. Illinois currently approves the substance for 39 different conditions, and California includes a blanket clause covering “any other chronic or persistent medical symptom…” that can’t be effectively treated with other medications.

However, it is safe to say that there is no consensus among Canadian physicians on what conditions, if any, can or should be treated with medical marijuana.

The Canadian Life and Health Insurance Association (CLHIA) takes the Health Canada position that medical marijuana has not been proven safe and effective.

However, the Canada Revenue Agency allows medical marijuana expenses under its Medical Expense Tax Credit provision, making it eligible under a Health Care Spending Account or Cost-Plus (MRP) arrangement.

A Human Rights Commission in Nova Scotia recently ruled that medical marijuana must be covered by drug plans. Shoppers Drug Mart and Loblaws recently announced that they would provide coverage of up to $1500 per year under their benefits plan.

These developments leave insurance providers somewhat caught in the middle. All those “more questions than answers” I mentioned at the start will have to worked out to some degree to make the cost of coverage – if nothing else – predictable and controllable in the world of drug plan benefits management.

One thing I can say for sure is that we’ll all be hearing a lot more about this issue in the months and years ahead. We’ll do our best to keep you posted.

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