General Information on Advocating for Private Insurance Coverage
- You must be already covered under a 3rd party extend health plan to get coverage.
- Health spending accounts often consider medical cannabis to be an eligible expense.
- There is currently no known coverage under any public health drug plans.
- Since cannabis has no Drug Identification Number (“DIN”) and is not generally considered a fully approved medicine, it is not automatically included in drug formularies (the list of eligible covered drugs)
- At this point, coverage for cannabis can only be obtained when it is purchased through fully legal sources of access (i.e. licensed producers).
- The plan sponsor (i.e. employer, student union, etc.) makes the final decision in most cases. Since medical cannabis is not covered under plans automatically, it is generally not worth approaching the insurer as they cannot add on coverage without the employer’s consent.
- It is helpful to have a supportive physician as they will be able to substantiate your claim.
Sample steps to seek coverage for medical cannabis
1. Gather any evidence you may have to support you claim
- Information and costs of previous medications/treatments
- Evidence of successful cannabis treatment
- Any other supporting documentation (i.e. letter from physician)
2. Contact your plan sponsor/administrator
- Note: Although this step is necessary, please keep in mind that there may be risk involved if your employer/administrator is not understanding of medical cannabis treatment.
- The plan administrator is the person/people who administer your health plan on behalf of the members (often HR, union representatives, student government executives, etc.)
- If your plan has a ‘special claim’ or ‘drug exemption’ process, follow those steps first.
- You are essentially asking for the administrator of the plan to ‘add’ coverage for medical cannabis as it is not a current eligible expense.
3. Wait for a response and if necessary, refute any objections
- Many patients face questions, concerns, and objections at this point
- Medical cannabis is a new area for many people, so we recommend educating people on how it’s used, purchased, prescribed, etc. so they understand what you are actually doing and seeking.
- There are already insurance plans that cover medical cannabis (most notably Veterans Affairs)
- It is helpful to provide a breakdown of the cost-benefit of medical cannabis compared to previous covered drugs and treatments, as financial risk and cost is important to both the plan sponsor and insurer.