As all of us know, the place of cannabis in Canadian society and health care has changed radically in recent years.
The legalization of recreational cannabis dominated the news cycle in 2018 with the Cannabis Act taking effect in October. This has generated similar media hype around medical cannabis and raised questions about its implications for health insurance. Recent Health Canada statistics suggest approximately 300,000 Canadians are registered to use cannabis for medical purposes, a number that has grown exponentially in recent years.
On October 1, 2018, Medavie Blue Cross introduced an optional medical cannabis extended health care benefit.
Here are answers to frequently asked questions related to benefit plan coverage for medical cannabis.
Question: What does Canada’s legislation governing medical cannabis allow?
Answer: The first regulations allowing limited access to cannabis for medical purposes were introduced in 2001 and have continued to evolve since then. The current law, Access to Cannabis for Medical Purposes Regulations (ACMPR), gives Canadians reasonable access to the drug by allowing them to produce a limited amount or designate someone to produce it for them, provided, of course, they are authorized to use the substance for medical reasons by their health care practitioner.
Question: Is cannabis treated differently than other prescription drugs?
Answer: Yes. Cannabis is a complex substance unique in the health benefits landscape. It is notably different from typical prescription drugs in several ways. Despite its legal status, it has not been approved by Health Canada as a therapeutic product and has not been given a Notice of Compliance (NOC) or Drug Identification Number (DIN).
Question: Why is cannabis not eligible for coverage under a drug plan?
Answer: In addition to not having a DIN, there is limited information around indications for its use, appropriate dosage, or potential interactions with other prescribed medications. These and other factors mean cannabis doesn’t meet typical requirements of group insurance policies to be eligible for coverage under a drug plan.
Question: What criteria must be met to purchase medical cannabis?
Answer: To become a registered patient and obtain medical cannabis, Canadian legislation requires an individual to receive authorization from their current health care practitioner, such as a physician or nurse practitioner. The health care practitioner then completes a document containing information on themselves and the patient and submits it to Health Canada to register the patient. To purchase cannabis, the patient must register with a licensed producer and order products via the company’s website to be delivered to their home.
Question: What is the Medavie Blue Cross approach to medical cannabis?
Answer: On October 1, we introduced a new extended health care benefit covering medical cannabis. The benefit is an optional, stand-alone coverage option for all group plan sponsors.
Our approach to medical cannabis balances providing appropriate access to care with science-based, clinical evidence and plan sustainability.
Question: What conditions does the extended health Care benefit cover?
Answer: The design of this benefit is based on a review of the strongest clinical evidence available regarding the efficacy of medical cannabis. This includes Canadian Family Physician Guidelines for prescribing medical cannabinoids and follows ACMPR requirements for patients and health care practitioners. Covered conditions include:
- Chronic neuropathic pain
- Refractory Pain in palliative cancer care
- Nausea and vomiting due to cancer chemotherapy
- Spasticity in multiple sclerosis or spinal cord injury
Coverage for other indications is not provided. Coverage is for fresh and dried cannabis and cannabis oil; other cannabis products and products related to the consumption of cannabis are ineligible.
Question: Why is the benefit restricted to those conditions?
Answer: While awareness of the medical use of cannabis has increased considerably and medical views on the topic have continued to evolve, peer-reviewed clinical evidence of its efficacy to treat various health conditions remains limited. Best available evidence supports the use of medical cannabis for treatment and alleviation of ailments for a few medical conditions after other conventional therapies have not been effective. Cannabis can affect patients differently depending on how it is consumed.
Question: How does the Optional Medical Cannabis Benefit work?
Answer: To qualify for reimbursement, plan members must receive pre-authorization and obtain medical cannabis in accordance with ACMPR legislation. Plan sponsors may choose annual benefit maximum options of $1,500, $3,000 or $6,000 (Insured plans are limited to $1,500).
Question: Can a Health Spending Account (HSA) be used for coverage?
Answer: Members of group benefit plans with Health Spending Accounts (HSAs) may receive reimbursement for medical cannabis independent of the new Extended Health Care benefit. Coverage amounts are limited to existing HSA maximums. While prior authorization is not required, plan members must still follow the ACMPR when obtaining medical cannabis.
Question: Will coverage change in the future?
Answer: We will continue to monitor the latest clinical evidence and emerging trends to assess the new benefit on an ongoing basis.
Still have questions?
For more information about this optional extended health care benefit, or to discuss adding it to your client’s group benefits plan, contact your Medavie Blue Cross account representative.