Medical marijuana and insurance

[obbn]

Hello Everyone,

Well, once again it appears that Florida citizens have gathered enough signatures to put the question of medical marijuana back up for a vote. I haven’t really been following the issue here all that closely, though I do have a personal interest in the outcome. As I’ve mentioned on here before (yeah, I get tired of listening to me complain too) I am a chronic pain patient and would love to have another option to control the pain other than the stupid opioids that I shove down my gullet. So, if the unthinkable happens and the State of Florida legalized pot, will the purchase of the drug be covered by insurance like any other script?

I assume that if you are able to use pot legally that you’ll be able to grow it on your property in some small quantity. If that’s the case will insurance provide you the starter seeds? I would think that they would want you to. If I’m treating my pain with homegrown vs having to get morphine from the pharmacy it would be less costs for them.

Last question, is marijuana a viable option for those of us in pain? Does it work as well as opioid painkillers? If it does, does that mean to get pain relief you have to be baked out of your mind to or are there certain strains that relieve pain without getting you high? This is very important as I no longer have my collection of Pink Floyd CD’s, a must if I’m going to be baked.

[Antinor01]

From my reading, I would say no, because it is an illegal drug at the federal level, so there can’t be a valid prescription for it. With no prescription, no coverage.

From the DEA website - http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section2.htm

IMPORTANT NOTE:

All drugs listed in Schedule I have no currently accepted medical use in treatment in the United States and therefore may not be prescribed, administered, or dispensed for medical use. In contrast, drugs listed in Schedules II through V all have some accepted medical use and therefore may be prescribed, administered, or dispensed for medical use.

Schedule I Substances

Substances in this schedule have no currently accepted medical use in treatment in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin; lysergic acid diethylamide (LSD); marijuana (cannabis); peyote; methaqualone; and methylene-dimethoxy-methamphetamine (“ecstasy”).

The CSA allows for bona fide research with controlled substances in Schedule I, provided that the FDA has determined the researcher to be qualified and competent, and provided further that the FDA has determined the research protocol to be meritorious. Researchers who meet these criteria must obtain a separate registration to conduct research with a Schedule I controlled substance.

[Moriarty]

The proposed Florida constitutional amendment would not allow you to grow your own plants. I have no idea whether insurance would cover the cost of buying from a dispensary.

[GaryM]

I don’t live in a MM state so I have a question.

Folks with MM cards get the card, or perhaps the authorization from an MD, right? But it’s not a prescription because if they wrote one perhaps they could lose their DEA number and be unable to write any prescriptions. So no prescription, no insurance coverage. Am I correct?

[Antinor01]

@GaryM

I don’t live in a MM state so I have a question.

Folks with MM cards get the card, or perhaps the authorization from an MD, right? But it’s not a prescription because if they wrote one perhaps they could lose their DEA number and be unable to write any prescriptions. So no prescription, no insurance coverage. Am I correct?

From my experience in the insurance industry, I would say no coverage. It’s not going to appear on any formulary, which is the standard for what is covered and what isn’t.

[alphaboi867]

@Antinor01

From my experience in the insurance industry, I would say no coverage. It’s not going to appear on any formulary, which is the standard for what is covered and what isn’t.

I’m also in the insurance industry, and there’s no way any insurance company in the US is going to cover medical marijuana. Even if the FDA reclassified it as Schedule II tomorrow it’d be a long time before anybody put in on their formulary (& just imagine what kind of prior auth requirements they’d have :eek:)

[WhyNot]

@obbn

So, if the unthinkable happens and the State of Florida legalized pot, will the purchase of the drug be covered by insurance like any other script?

Unlike what many people think, not everything is covered by insurance simply because a doctor writes a prescription for it. Every insurance company has a list of medications they cover, and what diagnoses they will cover them for. If your doctor’s choice of drug is not on that list, you can either pay for it out of pocket, or your doctor can choose another drug off the list. That list is called the “formulary”. The chances of marijuana being on any insurance group’s formulary in the next 20 years is slim to none.

So no, even when it’s made possible to obtain medical marijuana in your state, your insurance will not pay for it.

[obbn]

@WhyNot

Unlike what many people think, not everything is covered by insurance simply because a doctor writes a prescription for it. Every insurance company has a list of medications they cover, and what diagnoses they will cover them for. If your doctor’s choice of drug is not on that list, you can either pay for it out of pocket, or your doctor can choose another drug off the list. That list is called the “formulary”. The chances of marijuana being on any insurance group’s formulary in the next 20 years is slim to none.

So no, even when it’s made possible to obtain medical marijuana in your state, your insurance will not pay for it.

I’m well aware that insurance doesn’t cover many medications. Just this month I had to forgo a new med my doctor wanted me on. The insurance wouldn’t cover it and the pharmacy wanted $1200 for a months supply. What’s even worse is the insurance company no longer covering a drug that they’ve been c covering for years. Hell, just this month my copay for a 90 day supply of morphine went from $15 to $99. Somehow morphine went from a preferred generic to not. Something is telling me that insurance companies are gearing up for changes due to take affect with Obamacare.

I really didn’t think that insurance would cover MM, but who knows. Interesting that the proposed Florida changes will not allow someone to grow their own. I mean, we wouldn’t want to take the burden of paying for medication away from those who already have a difficult enough time affording it. But, I guess if you can grow your own medication, that doesn’t leave any profit in it for anyone else.

[Antinor01]

@obbn

I really didn’t think that insurance would cover MM, but who knows. Interesting that the proposed Florida changes will not allow someone to grow their own. I mean, we wouldn’t want to take the burden of paying for medication away from those who already have a difficult enough time affording it. But, I guess if you can grow your own medication, that doesn’t leave any profit in it for anyone else.

Profit is not the primary driver. The DEA is. As a schedule 1 drug, marijuana can’t be prescribed and is illegal under federal law. There is no pharmacy, no regulation, no standard and so on.

[Antinor01]

@alphaboi867

I’m also in the insurance industry, and there’s no way any insurance company in the US is going to cover medical marijuana. Even if the FDA reclassified it as Schedule II tomorrow it’d be a long time before anybody put in on their formulary (& just imagine what kind of prior auth requirements they’d have :eek:)

I was hedging just a little in case there was a loophole or something I was forgetting.

[Ornery_Bob]

@GaryM

I don’t live in a MM state so I have a question.

Folks with MM cards get the card, or perhaps the authorization from an MD, right? But it’s not a prescription because if they wrote one perhaps they could lose their DEA number and be unable to write any prescriptions. So no prescription, no insurance coverage. Am I correct?

In California, a medical marijuana state, you go to a doctor who specializes in this sort of thing (not your GP) and what you end up with is a “Physician’s Statement and Recommendation” that gives you the right to go to a medical marijuana “dispensary” and make a “donation” for the “meds” they offer. It’s about as far removed from the standard deal of getting a prescription that you take to a pharmacy for medication as you can imagine. You would laugh at the idea of insurance paying for it once you saw the reality of how it goes.

The doctor I went to did his consultation with me via Skype video. I was at an office in Los Angeles and I think he was in Berkeley. He was an ophthalmology resident doing consultations between real patients and he played the whole thing straight. He seemed genuinely concerned about my chronic pain and I thought the whole experience was well worth the twenty five dollar fee.