When Will Medicare Pay For Marijuana For Medical Purposes?
Many older people use medical marijuana to treat a wide range of health problems, but experts say it could be years before Medicare covers the drug. This is because there are different laws, unclear safety standards, and complicated rulemaking processes.
A poll done in April 2022 by the Medicare Plans Patient Resource Center, an organization that gives advice and information about Medicare, found that one in five Medicare recipients use medical marijuana. And almost a quarter of them have used it before. A poll found that two-thirds of people who get Medicare think it should be covered.
But Medicare doesn’t pay for medical marijuana because it’s not legal at the federal level and hasn’t been approved by the FDA. Here’s how things stand right now.
Why Should Older Adults Have Access to Medical Marijuana?
A paper published in April 2022 in the journal Cannabis and Cannabinoid Research looked at data from a large cannabis dispensary in New York. It found that 60% of patients were 50 or older. Patients used cannabis to treat, among other things, severe or long-term pain, cancer, Parkinson’s disease, and nerve damage.
And marijuana isn’t cheap. According to New York Cancer & Blood Specialists, which helps people with cancer and blood disorders, patients could pay as much as $5 per dose for edibles or $5 to $20 per gram for plant buds. (That’s somewhere between $142 and $567 per ounce.) Even in states where it is legal to get a prescription for medical marijuana, patients might not be able to pay for it.
Debbie Churgai, who is the executive director of Americans for Safe Access, says, “This medicine is so expensive.” Americans for Safe Access is a non-profit group that works to make sure people have safe and legal access to cannabis for medical use and research. “In some states, insurance will cover the cost of seeing a doctor or getting a marijuana card, but it won’t cover the cost of the products themselves.”
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What Are Federal Roadblocks?
There are two big problems that keep Medicare from covering medical marijuana. The first is that the government says marijuana is a Schedule I drug, which means it has “no currently accepted medical use and a high potential for abuse.” This is what the Drug Enforcement Administration says about drugs in this category in the United States.
Paul Armentano, deputy director of NORML, the National Association for the Reform of Marijuana Laws, says, “The federal government will never reimburse people through a federal program for something they think is illegal.”
The second problem is that Medicare requires the FDA to say that a drug is safe and effective before Medicare will pay for it. Even though the FDA has approved for prescription use one drug made from cannabis and three drugs that are similar to cannabis but not made from cannabis, the agency has not approved the sale of cannabis for medical treatment.
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What About States Where It’s Legal?
Marijuana is against the law at the federal level, but it is now legal for medical use in 37 states and D.C. Could private insurance companies decide to cover it? For example, companies that offer Medicare Advantage might do so.
Kyle Jaeger, who writes about cannabis policy and is the senior editor of the cannabis news site Marijuana Moment, says it’s not likely. As with banks, which have been hesitant to work with marijuana businesses, it is likely that major health insurers will not cover cannabis as long as it is still a Schedule I drug under federal law.
Also, private insurance companies use information from the FDA to decide which drugs to cover. Consider that the FDA said in January that the current ways of regulating CBD are not enough for the agency to classify it as a food supplement.
“It’s incredibly frustrating for consumers because all they want is a safe, consistent product,” Jaeger says.
How Hard Is It to Get Coverage for Cannabis?
Among other things, the market needs more information about how cannabis can be used as a medicine. “(Insurers) need data to show that the results of cannabis care are the same as, or even better than, existing options that they do cover,” says Dr. Benjamin Caplan, founder and chief medical officer of CED Clinic, which helps people find cannabis treatment.
Part of what makes this hard is that patients can buy any product they want from free-market dispensaries. Caplan says, “The system needs to be tweaked.” “Patients can’t just buy whatever they want and expect their insurance companies to pay for it.”
Jaeger says that it will take a long time for cannabis to be covered because there are a lot of legal and regulatory problems to solve and the dispensary system needs to be changed. “I’d say it will be a long time before we talk about that and make rules for something like Medicare.”
