Medical Marijuana: Considerations For Plan Sponsors | Benefits Canada

The new rules for using medical marijuana involve the following: obtaining a prescription from any licensed physicianso access to prescriptions will not be a challenge for a plan member, its not as though they will need to wait to see a specialist; that prescription is forwarded to one of the licensed growers of their choice; producers of medical marijuana will consult with patients with respect to appropriate products and strains; delivery by courier is requiredthere will be not retail access to medical marijuana, and patients will be limited to 150 grams per month of dried buds. Based on a 150 gram per month maximum, some patients could be looking at out-of-pocket costs of $1,800 per month or more than $20,000 per year. This is where plan sponsors may start to find more pressure from members to look at how they will cover medical marijuana under existing drug benefits plans. Here are some of the issues that are on the table for plan administrators, claims processors, plan sponsors and their advisors to consider: Will medical marijuana be covered at all under third-party plans if prescribed by a licensed physician? If so, for what disease states/uses, or will there be any controls over what its allowed to be used to treat? Since medical marijuana will not have a drug identification number because the product cannot be regulated and controlled by Health Canada, how will it be handled by private plans? Will plan administrators issue product identification numbers (PINs)? Will PINs be issued for all licensed growers or just those who have been validated by various third-party payers?
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