Legislative changes along with a new political environment in Canada mean the topic of medical marijuana will likely pick up steam in the coming months and years.

While much is unclear, Mike Sullivan lays out important factors for benefit plan sponsors to weigh in his article, “Clearing the Haze: Medical Marijuana Considerations for Plan Sponsors,” the cover article in the January/February issue of Plans & Trusts. Sullivan is co-founder and president of Cubic Health Inc. a Toronto-based health benefit analytics and drug plan management company.

Health Canada does not endorse the use of medical marijuana. Medical marijuana has neither Health Canada approval as a “drug” nor a drug identification number. Most health plans require both to be eligible for reimbursement, so they haven’t covered medical marijuana in the past.

[Related: Canadian Health and Wellness Innovations Conference, February 14-17, Phoenix, Arizona]

But with the Liberal Party now in control of the federal government, there has been more discussion about the legalization of marijuana. Sullivan predicts plan sponsors will feel even more pressure to consider including coverage of medical marijuana in their benefit plans.

He outlines some of the major considerations:

• Cost and plan design: At the end of 2015, licensed producers charged an average price of $7.50 per gram. Assuming use of up to 3 grams per day, the annual cost could easily exceed $8,000, elevating medical marijuana to the realm of a specialty drug from a cost perspective. Plan sponsors will need to look at current plan design and eliminate inefficiencies to be in a position to absorb those additional costs.
• Dosing and use: Current legislation doesn’t restrict the daily amount of medical marijuana that can be authorized, although there is a possession limit. While so far there is little conclusive scientific evidence of medical marijuana’s effectiveness, the list of conditions it treats is rapidly growing. Patients don’t have to disclose to a licensed producer their reason for taking the product. The lack of dosing restrictions and ever-growing list of applications would make it challenging for plan sponsors, claims processors and insurance carriers to manage claims.
• Legal: Some workplaces have zero-tolerance policies for drugs and alcohol, and it will take time to determine how medical marijuana will be considered (if at all) in such environments.  There also are legal questions related to an employer’s duty to accommodate a member’s medical conditions.

Because of all the uncertainty surrounding coverage of medical marijuana and the fact that the medical marijuana industry is in its infancy, Sullivan recommends plan sponsors revisit the issue annually.

Kathy Bergstrom, CEBS
Editor, Publications at the International Foundation