(NerdWallet) – Many older adults use medical marijuana to treat a variety of conditions, but experts say conflicting laws, unclear safety standards, and a complex rulemaking process have pushed Medicare It may be years before the drug can be covered.
One in five Medicare beneficiaries currently uses medical marijuana, according to an April 2022 poll by the Centers for Medicare Plan Patient Resources, an organization that provides Medicare guidance and information. And nearly a quarter have used it in the past. According to the survey, her two-thirds of Medicare beneficiaries think Medicare should cover it.
But Medicare doesn’t cover medical marijuana because medical marijuana isn’t federally law and isn’t approved by the Food and Drug Administration.
Why Cover Medical Marijuana for Seniors?
An April 2022 paper in the journal Cannabis and Cannabinoid Research found that 60% of patients were over the age of 50 when analyzing data from a large cannabis dispensary in New York. Patients used cannabis for severe or chronic pain, cancer, Parkinson’s disease, neuropathy, and more.
Also, marijuana is not cheap. Patients can pay as much as $5 per dose for edible products and $5 to $20 per gram for plant sprouts, according to New York Cancer & Blood Specialists, which provides treatments to patients with cancer and blood disorders. I have. (This is about $142 to $567 per ounce.) Even in states where medical marijuana can be legally prescribed, patients may not be able to afford a prescription.
“This drug is very expensive,” said executive director of Americans for Safe Access, a nonprofit dedicated to ensuring safe and legal access to cannabis for therapeutic use and research. Debbie Churgai says, “There are some states that have insurance that covers the cost of a doctor’s appointment or the cost of a marijuana card, but there is no insurance that covers the cost of the actual product.”
What is a Federal Obstacle?
There are two key issues between medical marijuana and Medicare coverage. First, the government has classified marijuana as a Schedule I drug, a category of drugs in the United States that “has no current accepted medical use and a high potential for abuse,” according to the Drug Enforcement Administration. .
“There is no way the federal government can reimburse people for substances they deem illegal through federal programs,” said Paul Armentano, deputy director of the National Marijuana Law Reform Association NORML.
A second problem is that Medicare requires that the FDA approve the drugs it covers as safe and effective. The FDA has approved one cannabis-derived drug and three synthetic cannabis-related drugs for prescription use, but the FDA has not approved the marketing of medical cannabis.
What about in states where it’s legal?
Yes, marijuana is illegal at the federal level, but medical marijuana is now legal in 37 states and Washington, DC. For example, can a private insurer, such as a company that offers Medicare Advantage, decide to cover it?
It’s unlikely, says Kyle Yeager, cannabis policy reporter and senior editor at cannabis news site Marijuana Moment. Health insurers are likely to deny cannabis coverage as long as cannabis remains a Schedule I drug under federal law.
Private insurers also rely on the FDA to determine which drugs are covered. Considering that the FDA issued a statement in January stating that the current regulatory pathway is insufficient for the agency to classify CBD as a dietary supplement.
“This is very frustrating because consumers only want safe and consistent products,” says Jaeger.
What are the criteria for cannabis coverage?
Above all, the market needs more data on the medical uses of cannabis. “[Insurers]need data to show that cannabis care outcomes are comparable to or better than the existing options they cover.” People Seeking Cannabis Treatment.
This is partially complicated by the free market pharmacy system, where patients are free to purchase any product. “The system needs to be tweaked,” he says Caplan. “Patients are not free to buy what they want, and insurance companies are responsible for covering it.”
Given the breadth of legal and regulatory hurdles facing the process, plus an overhaul of the pharmacy system, cannabis has a long way to go for coverage, Jaeger says. “I think it will take years to have that kind of conversation and rulemaking for something like Medicare.”