Does Health Insurance Cover Medical Cannabis?

With medicinal marijuana becoming increasingly popular across the United States, one major question keeps popping up again and again among the thousands of would-be users: “Will my health insurance cover medical marijuana?”

Unfortunately, the answer is pretty much a resounding NO. Read on to find out why insurance companies are afraid (and even unable) to mingle with marijuana, and what the future is looking like in terms of any possible changes.

Why Doesn’t Health Insurance Cover Medical Marijuana?

On the surface, the argument seems like a pretty straightforward scenario: You pay for your health insurance, which covers treatments recommended by the physician(s) you see, right? So, if a physician officially recommends you be treated with cannabis (as is actually required by law in any state where medical marijuana is legal), wouldn’t it seem that the insurance company has to pay for the recommended medication?

Well, not quite. One of the major reasons (actually pretty much THE reason) why health insurance companies are unwilling and unable to cover anything cannabis related is because the substance is not approved by the Food and Drug Administration (FDA) as a medicine.

Of course, there are some exceptions and complex legalities that may act as loopholes, but in general, private health insurance companies, as well as Medicare (federal health coverage for senior citizens) and Medicaid (federal coverage for low-income citizens), are required by law to cover FDA-approved drugs. Since marijuana is not an FDA-approved drug, providers are “not allowed” to cover it—even if they want to.

This brings about a whole other topic of discussion in terms of what power insurance companies have over managing drug prices, but as for medical marijuana, basically, all it means is that patients are SOL in terms of having their insurance providers offer any cannabis-related coverage or even reimbursements on money that is spent out of pocket. (If you’re unfamiliar with what SOL means, let’s just say it’s a nice way of saying you’re screwed.)

Also, there is no ignoring the fact that marijuana is currently still classified as a Schedule I narcotic, according to the Drug Enforcement Administration (DEA). This means, among other things, that it has a “high risk for addiction and no recognized medical value. Crazy, right? Tell the idea that it has “no recognized medical value” to the literally thousands of scientific studies that have PROVED otherwise.

In any regard, no insurance company in the world would cover a medication that the government defines as having “no medicinal value”—it just wouldn’t make sense.

Again, this brings up another very relevant argument: Why don’t insurance companies have more power over what they can and cannot cover? Or, for that matter, what they can and cannot cover? Many people argue that the federal government telling a private organization (i.e., an insurance company) what it is and isn’t allowed to spend money on is a breach of the constitution, but for now, that’s just the way it goes.

In reality, the whole FDA/insurance relationship is actually quite a complicated situation, at least in terms of simplicity for the average patient. On the one hand, you definitely need a trusted organization (i.e., the FDA) that oversees the drugs that are available to citizens, but on the other hand, if said organization essentially mandates that health insurers have to provide coverage for approved medications, all that really happens is that the majority of the power gets put into the hands of the drug manufacturers – in other words, into the hands of Big Pharma. However, that’s a discussion for another time and another place.

Other Reasons Why Health Insurance Won’t Cover Medical Marijuana

As we previously stated, the FDA’s lack of approval or recognition of marijuana is essentially the only reason why insurance companies don’t cover it. However, here’s a few more reasons why their hands are tied in terms of giving patients money to buy weed:

• Lack of Clinical Research: Health insurance companies do have somewhat of a say in terms of what products/drugs they will and won’t cover, but generally, what they want to see are drugs that have been rigorously tested through multiple clinical trials. And more importantly, through double-blind studies.

However, for all of the positive research that has been done on marijuana and other cannabis-related products, data is still severely lacking in terms of actual clinical evidence. For this reason (and until large-scale clinical data IS available for marijuana as a medication), insurance companies aren’t going to touch it.

• “Researchable Product” is Unavailable (and/or Illegal): Of course, the major issue with the aforementioned problem (i.e., the lack of clinical trials and double-blind studies) is that researchers can’t get ahold of the appropriate amounts of marijuana that would be required to even think about doing a large-scale clinical trial. This is directly due to the fact that cannabis is a Schedule I substance — no money is going to be available to research a drug that is illegal, and even if it WERE available, conducting the research in itself would be illegal without proper authorization (which is difficult and costly to get). Quite the catch-22 type of situation, if there ever was one.

So, Do We Have Any Hope of Health Insurance Covering Marijuana in the Future?

As it looks right now, the long-term future of marijuana legality is still pretty bleak, at least on the federal level. Things are obviously on the uptrend within individual states, but marijuana reform activists are still treading water in terms of trying to get the Feds to acknowledge our beloved cannabis.

One thing that does have a possibly brighter outlook than whole-plant marijuana, however, is CBD oil and other CBD-based products.

We won’t go into much detail in this article, but CBD is a compound in marijuana that offers loads of therapeutic benefits without the high. Most people use it as an infused oil tincture, and there have been dozens and dozens of reputable studies done showing that it has an extremely positive safety profile and that it is virtually non-existent in terms of addiction. For that reason, there has been talk of the FDA looking into approving CBD as a medication, but again, this is still a ways off – if it even happens at all.

Does Health Insurance Cover Synthetic Marijuana Drugs?

Of course, there have been a few synthetic forms of marijuana that the FDA has approved over the years. Marinol is probably the most famous one, as it’s been an approved medication for over 30 years — since 1985. However, most real cannabis users will tell you that it’s far from the “real thing” in terms of effectiveness – it takes forever to take effect, and it poses a fairly high risk of promoting states of depression and anxiety.

Similar to Marinol/Dronabinol (Dronabinol is the generic name), Syndros is a much more recent synthetic marijuana drug that has received FDA approval (in liquid form, the first of its kind), and it is also federally classified as a Schedule III substance, meaning it has an “accepted medical use and low to moderate potential for abuse.”

So what about these? Are synthetic marijuana drugs covered by health insurance, considering that they’re FDA-approved?

In fact, yes, they are. Along with the other two FDA-approved synthetic cannabinoids, Marinol is a relatively frequently prescribed drug for chemotherapy patients to increase appetite and lessen nausea and vomiting.

However, like we said, most patients who use these drugs will tell you that they’re not quite the real thing – they would much rather be able to smoke actual cannabis.

Final Thoughts: Is Medical Marijuana Covered by Health Insurance

As we previously stated, no health insurance companies will offer coverage for medical marijuana until the FDA has approved it and doctors are legally able to prescribe it. Until that day comes (or if it EVER comes), patients will continue to be forced to pay for their cannabis meds out of pocket, with no potential for deductions or reimbursements.

There are a few synthetic marijuana drugs that are FDA-approved and available for health insurance coverage, but as we mentioned, these medications are not quite the same thing in terms of the whole-range therapy (and minimal side-effects) that real cannabis provides.