Why Health Insurance Won’t Pay for Medical Marijuana
James Lacy, MLS, is a fact checker and researcher. James received a Master of Library Science degree from Dominican University.
If you live in a state where medical marijuana use has been legalized (33 states and DC as of early 2020), it’s tempting to assume that your health insurance will pay for it like other drugs prescribed by your physician. However, you’d be wrong; health insurance won’t pay for medical marijuana even in states where its use has been legalized. Why won’t health insurance pay for medical marijuana when it will pay for all sorts of other drugs, many arguably more dangerous and prone to abuse?
Medical Marijuana Is a Schedule I Drug
Health insurers in the United States won’t pay for anything that’s technically illegal. Most health insurance policies include an illegal acts exclusion saying that health issues occurring due to or in association with your voluntary involvement in an illegal act are not covered. Even though medical marijuana may have been legalized in the state where you live, it’s still classified by the federal government as a schedule I controlled substance as defined by the Controlled Substances Act. It’s still illegal to use marijuana in terms of federal law.
In addition to health plan illegal acts exclusion clauses, another issue arises due to marijuana’s Schedule I designation. Schedule I controlled substances can’t be prescribed by physicians.
Physicians who prescribe controlled substances must be registered with the Drug Enforcement Administration and have a DEA number. Prescribing a Schedule I drug, even in a state where medical marijuana has been legalized, would place a physician at risk of having his or her DEA registration revoked. Even if medical marijuana has been legalized in your state, as long as it’s considered a Schedule I drug by the federal government, prescribing it would put your physician at risk of losing his or her ability to prescribe even simple controlled substances like sleeping pills and cough syrup with codeine.
For this reason, most physicians don’t prescribe medical marijuana. In states that have legalized its use, physicians recommend medical marijuana rather than prescribe it (Cigna describes how a doctor can write a “certificate” that the patient can take to a medical marijuana dispensary). That brings us to stumbling block number two.
Health Insurance Won’t Pay for Medical Marijuana If It’s Not on the Drug Formulary
Even if the U.S. were to change marijuana to a schedule II or III drug—thereby allowing its prescription and decriminalizing its medical use across the country—your health insurance company probably still wouldn’t pay for your medical marijuana. Likewise, if congressional action were to remove marijuana from the list of controlled substances altogether, your health plan probably still wouldn’t pick up the tab for your Alice B. Toklas brownies even if your doctor recommended them.
Each health plan has a drug formulary, a list of medications it covers for health plan members. Your health plan’s pharmacy and therapeutics committee would have to add marijuana to its drug formulary before it would be a covered benefit of your health insurance.
It would be highly unusual for a health plan to add a drug to its formulary if the drug hasn’t been FDA approved. Getting new drug approval from the FDA requires clinical studies to determine both the drug’s safety and that the drug is effective. Clinical studies are complicated and expensive to perform. So, when the FDA grants a new drug approval, it also grants a period of time in which the company given the new drug approval has exclusive rights to manufacture and sell the drug in the United States.
If you think it costs a lot now, wait until Pfizer, Merck, AstraZeneca or another big pharma company gains the exclusive right to bring marijuana to market in the United States.
Without FDA approval, it won’t get on your health plan’s drug formulary, so your health insurance won’t pay for medical marijuana. The process of getting marijuana approved would almost assuredly involve big pharma, exclusive marketing rights, and exorbitant costs. You can read more about this in an article about marijuana that the FDA published.
The FDA has, however, approved Marinol (in 1985) and more recently, Syndros (in 2016). Both contain a synthetic form of THC. In 2018, the FDA approved Epidiolex, a CBD oral solution for treating seizures associated with two forms of epilepsy. Although these drugs are not the same thing as cannabis, they can be prescribed just like any other FDA-approved medication, and do tend to be covered by health insurance plans.
Health Insurance Won’t Pay for Medical Marijuana as an Herbal Remedy
If marijuana was to be reclassified so that it wasn’t a controlled substance at all, it might become available without a prescription. However, those who think that’s the answer to getting medical marijuana covered by health insurance are misguided.
When a drug becomes available without a prescription, it’s removed from health plan drug formularies and you’re expected to pay for it yourself. Does your health insurance currently reimburse you for over-the-counter medications like Tylenol? Most don’t. Does it cover herbal remedies like St. John’s wort or echinacea? That’s unlikely.
In this situation, patients who would benefit from using marijuana would be able to buy it over-the-counter like any other herbal remedy. As they are now, those patients would be highly motivated to find a way to pay for it themselves. Why would your health insurance want to set a precedent of paying for over-the-counter drugs or herbal remedies that you’re willing to pay for yourself?
Will Things Change?
In summary, there’s more than one reason why your health plan won’t pay for medical marijuana. Even if marijuana was reclassified to a lower schedule or congressional action removed it from the list of controlled substances altogether, that wouldn’t be like waving a magic wand. Your health plan wouldn’t magically start paying for your medical marijuana a month or two later. Instead, it would be the beginning of a long, slow, process.
If the process ended up with marijuana being an FDA approved drug, it might eventually be covered by your health plan as a prescription drug on its drug formulary. However, that would be years, not months, down the road. If, even more surprisingly, marijuana ended up as an herbal remedy not requiring FDA approval, it remains highly unlikely that your health insurance would pay for it.Learn about why health insurance won't pay for medical marijuana, and why reclassification of marijuana won't make your health plan pay either.
- Topic Overview
- Related Information
What is medical marijuana, and is it legal?
Marijuana is a drug that is made up of the leaves, flowers, and buds of the hemp plant Cannabis sativa. Medical marijuana is the use of this drug to help treat symptoms like pain, muscle stiffness ( spasticity ), nausea, and lack of appetite. It may be used by people who have conditions like cancer, AIDS, or multiple sclerosis.
In the United States, it is against federal law to possess, sell, give away, or grow marijuana for any purpose. Many states have passed laws that allow people with certain health problems to buy or grow marijuana for their own use. Some states allow or license people to provide medical marijuana to those who need it. And in some states your doctor can write a certificate for you to be able to buy medical marijuana from a state-licensed dispensary.
If you use medical marijuana to treat an approved medical condition, the federal government might not prosecute you. But there’s no guarantee.
Medical marijuana laws vary from state to state. If you think you might want to try medical marijuana, talk to your doctor. You can also call your state department of health or health services to learn more about the laws in your state.
What do the experts say?
The medical use of marijuana has been studied for decades. But experts still don’t agree on how safe it is or how well it works.
Some medical experts don’t recommend marijuana because:
- It hasn’t been approved by the Food and Drug Administration.
- Marijuana may impair your memory, judgment, and coordination. It can increase your risk of being in a car crash.
- Marijuana smoke may harm your lungs.
- There are legal drugs that may work just as well, such as new kinds of pain and nausea medicines.
Other medical experts do recommend marijuana because:
- It can provide pain relief when normal pain medicines don’t work or have unwanted side effects.
- It can improve appetite and relieve nausea in people who have cancer or AIDS.
- It may help relieve symptoms such as pain and muscle stiffness (spasticity) in people who have multiple sclerosis.
Be sure to let your doctor know if you are using medical marijuana. If you’re pregnant , it is not safe to use alcohol or drugs, including marijuana.
How do you use medical marijuana?
Medical marijuana should only be used after treatments with commonly used medicines have been tried. Marijuana interacts with many other medicines. It can be dangerous if taken with medicines that cause sleepiness or control mood, such as sedatives, anxiety drugs, or antidepressants. Marijuana lowers blood sugar and blood pressure, so use caution if you take medicines for these conditions. It also increases the chance of bleeding if you are taking blood thinners.
Marijuana is usually smoked. It can also be brewed into tea, vaporized, sprayed under the tongue, applied to the skin, or cooked in food.
You may be affected for hours after you use marijuana. How soon you feel the effects of marijuana and how long they last depends on many things, including:
- How much you used.
- How you took it.
- How your own body responds to it.
Unwanted side effects may include:
- Dry mouth.
- Red eyes.
- Anxiety or paranoid thoughts.
- Faster heart rate.
- Nausea and vomiting.
Can marijuana use lead to cannabis use disorder?
Some people who use marijuana develop cannabis use disorder. Severe cannabis use disorder is sometimes called addiction. This means that they keep using marijuana even though it’s having harmful effects on their lives.
The risk of cannabis use disorder is higher in people who:
- Start using marijuana when they’re young.
- Use it every day.
- Have mental health problems.
People who use marijuana often and then quit may have withdrawal symptoms. These include anxiety, trouble sleeping, and intense cravings for the drug.
Are there alternatives to medical marijuana?
Doctors can prescribe two legal alternatives: dronabinol (Marinol) and nabilone (Cesamet). Both of these drugs contain a man-made form of THC, the main chemical in marijuana.
Nabilone is used to relieve nausea and vomiting caused by cancer chemotherapy. Dronabinol can relieve this kind of nausea and vomiting too. It may also improve the appetite of people who have AIDS. Both dronabinol and nabilone can be used to relieve pain and spasticity in people who have multiple sclerosis. Both drugs come in pill form.
Talk to your doctor if you think these medicines might help relieve your symptoms.
What is synthetic marijuana?
Synthetic marijuana is made of dried plant material that is treated with chemicals that produce effects like marijuana’s effects. It is sold in the form of incense under many names, such as K2 or Spice. The labels often claim that these products are “safe” or “natural.” But in fact, the active chemicals are created in a lab. And they could be dangerous.
But young people often try these products because they are easy to buy and they may not be detected by drug tests.
People think that using these drugs will make them feel the same as when they use marijuana. But these drugs are different from marijuana. And the effects are hard to predict. That’s because the type and strength of the chemicals used are often unknown. Some people have reported severe symptoms, such as:
- Fast heart rate and high blood pressure.
- Feeling agitated or confused.
- Feeling like others want to harm them (paranoia), or seeing or hearing things that aren’t there (hallucinations).
- Pain Management
- Cancer: Home Treatment for Nausea or Vomiting
Other Works Consulted
- Aggarwal SK, et al. (2007). Dosing medical marijuana: Rational guidelines on trial in Washington state. Medscape General Medicine, 9(3): 52. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100129.
- American Lung Association (2012). Health hazards of smoking marijuana. Available online: http://www.lung.org/stop-smoking/about-smoking/health-effects/marijuana-smoke.html.
- Fallik D (2010). As another state approves medical marijuana, neurologists urge caution about prescribing. Neurology Today, 10(4): 1, 5–7.
- Johnson JR, et al. (2010). Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. Journal of Pain and Symptom Management, 39(2): 167–179.
- National Cancer Institute (2013). Cannabis and Cannabinoids PDQ – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional.
- National Institute on Drug Abuse (2011). Marijuana: Facts for Teens (NIH Publication No. 10-4037). Available online: http://www.nida.nih.gov/marijbroch/teenpg13-14.html.
- National Institute on Drug Abuse (2012). DrugFacts: Marijuana. Available online: http://www.drugabuse.gov/publications/drugfacts/marijuana.
- National Institute on Drug Abuse (2012). DrugFacts: Spice (Synthetic Marijuana). http://www.drugabuse.gov/publications/drugfacts/spice-synthetic-marijuana. Accessed September 30, 2013.
- National Institute on Drug Abuse (accessed June 2011). Is there a link between marijuana use and mental illness? Research Report Series: Marijuana Abuse. Available online: http://www.nida.nih.gov/researchreports/marijuana/marijuana4.html.
- U.S. Department of Justice (2011). DEA Position on Marijuana. Available online: http://www.justice.gov/dea/pr/multimedia-library/marijuana_position.pdf.
- U.S. Food and Drug Administration (2006). Inter-agency advisory regarding claims that smoked marijuana is a medicine. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108643.htm.
- Yadav V, et al. (2014). Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(12): 1083–1092.
Current as of: December 19, 2019
Author: Healthwise Staff
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine