Medical marijuana is legal in over three-quarters of U.S. states, Medicare does not cover it because federal law classifies marijuana as an illegal Schedule 1 controlled substance. However, there is a slight exception: Part D prescription plans can cover certain FDA-approved cannabis-derived drugs when prescribed by a doctor for specific medical uses.
Does my state allow medical marijuana?
Despite the federal classification of marijuana as an illegal substance, 38 states, the District of Columbia, and the territories of Guam, Puerto Rico, and the U.S. Virgin Islands permit the medical use of cannabis products, according to the National Conference of State Legislatures (NCSL). Only Idaho, Kansas, and Nebraska lack public access programs, though Kansas allows patients with debilitating medical conditions to use a doctor’s recommendation for qualifying CBD products as a defense in encounters with law enforcement.
Nine states — Georgia, Indiana, Iowa, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming — do not have medical cannabis laws but do permit certain CBD and low THC products, according to the NCSL and the National Organization for the Reform of Marijuana Laws (NORML).
In which states is medical marijuana available?
In February 2022, Mississippi became the 37th state to legalize marijuana for medical use. Additionally, medical marijuana is legal in four U.S. territories and the District of Columbia. However, marijuana remains illegal at the federal level, as it is classified as a Schedule 1 controlled substance.
Controlled substances are medications and substances that the federal government deems to have a high risk of dependence and misuse. Schedule 1 controlled substances are defined by the U.S. government as having “no currently accepted medical use and high potential for abuse.” Consequently, federal law prohibits healthcare providers from prescribing marijuana.
What cannabis-derived drugs does Medicare cover?
Medicare Part D plans can cover two FDA-approved cannabis-derived drugs: cannabidiol (CBD) and dronabinol.
Cannabidiol (CBD) is a chemical component of the cannabis plant. The FDA has approved the medication, brand name Epidiolex, to treat seizure disorders associated with three rare and severe forms of epilepsy: Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis. According to the Epilepsy Foundation, most epilepsy patients eligible for Epidiolex are children and young adults.
Epidiolex is an anticonvulsant, one of six protected classes of drugs that Part D plans must cover. However, plans typically require prior authorization and detailed information from your doctor about your condition and treatment plan before covering Epidiolex. Patients may also need to try one or two types of antiepileptic drugs before Epidiolex is approved. Epidiolex is generally included in Part D Tier 5 plans, which cover specialty drugs and can have high cost-sharing, according to the Epilepsy Foundation.
Does Medicare cover FDA-approved cannabinoid-based medications?
There are three FDA-approved prescription medications that contain cannabinoids. Healthcare providers can prescribe these medications, and Medicare may cover them if you’re eligible. The FDA-approved cannabinoid-based medications are:
- Epidiolex: Approved to treat rare forms of epilepsy such as Lennox-Gastaut and Dravet syndromes.
- Marinol and Syndros (dronabinol): Used to treat nausea and vomiting in people undergoing chemotherapy for cancer, and to treat anorexia or significant weight loss in people with HIV/AIDS.
- Cesamet (nabilone): Approved to treat nausea and vomiting in people receiving chemotherapy for cancer.
These medications may be included in Medicare Part D formularies and Medicare Advantage plans. Epidiolex has the most coverage, with nearly all Medicare private plans covering it, according to FormularyLookup.com. However, you may face restrictions such as prior authorization or step therapy. About one-third of private plans cover Marinol and Syndros, and you might need preapproval or to try another therapy first before your plan will pay for these medications.
Can healthcare providers prescribe medical marijuana?
By law, healthcare providers can’t prescribe medical marijuana. However, in states where medical marijuana is legal, they can recommend it or make a referral to a state dispensary, which is a designated store where marijuana is sold.
Medical marijuana may be useful for the same reasons as FDA-approved cannabinoid medications. Additionally, it may be beneficial for other medical conditions, including:
- Chronic pain from various medical conditions
- Anxiety
- Depression
- Glaucoma
- Crohn’s disease
- Multiple sclerosis (MS)
- Amyotrophic lateral sclerosis (ALS)
- Epilepsy and seizures
- Parkinson’s disease
- Anorexia
- Insomnia
What does medical marijuana cost?
In some areas, the expenses associated with obtaining medical marijuana can exceed the cost of the marijuana itself. According to the advocacy group Safe Access Now’s State of the States 2021 report, medical marijuana customers at state dispensaries might incur costs of up to $350 before purchasing marijuana.
Fees related to obtaining medical marijuana can vary by state and typically include:
- A visit to a healthcare provider’s office to certify eligibility for medical marijuana use.
- A fee for obtaining the medical marijuana license.
- A fee for using the medical marijuana card at the dispensary.
These costs are part of the process in states where medical marijuana is legal and are intended to cover administrative and regulatory expenses associated with accessing and using medical marijuana.
Can I use my health savings account (HSA) to pay for medical marijana?
Yes, it’s advisable to inform your healthcare provider if you are using marijuana, whether it’s for medical or recreational purposes. This information is important because healthcare providers and pharmacists need to be aware of all substances you are using, including supplements, vitamins, and medications, to screen for potential drug interactions and ensure your safety.
Discussing marijuana or CBD use with your healthcare provider may feel daunting, but it is essential for your overall care. Marijuana can interact with medications that affect your nervous system, potentially posing risks that outweigh its benefits in certain cases.
For U.S. veterans receiving care through Veterans Affairs (VA), it’s important to note that VA healthcare providers cannot deny care based on marijuana use. They are permitted to discuss the risks and benefits of medical marijuana with you, but due to federal regulations, they cannot recommend its use or prescribe it. However, if you use medical marijuana, the VA may document this in your confidential medical records to assist in treatment planning.
When will medical marijuana be covered by insurance, like other prescription medications?
Currently, Medicare does not cover medical marijuana because it remains illegal at the federal level. Federal legalization is necessary for potential FDA approval and regulation, which are prerequisites for Medicare coverage of medical marijuana.
Although the U.S. House of Representatives passed bills in 2020 and 2022 to legalize marijuana, these bills did not pass in the U.S. Senate. As a result, marijuana remains classified as a Schedule 1 controlled substance under federal law, limiting its legal use and preventing Medicare from covering it as a medical expense.
Can I assume that nonprescription cannabis products are labeled accurately?
When purchasing cannabis products for medical purposes, it’s crucial to consider label accuracy and quality control. Unlike FDA-regulated medications, medical marijuana products may not always accurately reflect their chemical composition on the label. This lack of regulation can lead to discrepancies where the actual content of THC (tetrahydrocannabinol), CBD (cannabidiol), or other compounds differs from what is stated on the product label.
Research underscores these concerns. For example, a study examining 75 cannabis products across three U.S. cities found that over 80% of the products were mislabeled. This mislabeling included instances where products contained higher or lower amounts of THC or CBD than indicated on the label. Another review of five studies reported that cannabis product labels were inaccurate between 17% to 86% of the time.
These findings highlight the importance of sourcing medical marijuana products from reputable dispensaries that prioritize quality control and testing. Patients should also consider discussing product options with their healthcare providers to navigate these complexities and ensure they receive reliable and effective treatment.
