What is Medicare’s Coverage for Medical Marijuana?

Many seniors are turning to medical marijuana for treatment of a wide range of conditions. However, experts warn that there are conflicting laws and unclear safety standards, making it difficult for Medicare to cover the drug.

According to a poll conducted by the Medicare Plans Patient Resource Center in April 2022, one fifth of Medicare beneficiaries currently use medical marijuana. This is according to an organization that provides guidance and information about Medicare. Nearly a quarter of those who have used it previously use it. The poll revealed that two-thirds (63%) of Medicare recipients believe Medicare should cover it.

Medicare does not cover medical marijuana, as it is not legalized in the United States and has not been approved by the Food and Drug Administration. Here is the current situation.

According to a paper published in Cannabis and Cannabinoid research, 60% of the patients in a New York cannabis dispensary were over 50. Patients used cannabis to treat severe pain or chronic pain, neuropathy, Parkinson’s disease, and cancer.

The price of marijuana is high: Patients may pay $5 for edible products and $5 to $20 for cannabis buds. According to New York Cancer & Blood Specialists (which provides treatment for patients with blood disorders and cancer), the prices can be quite steep. This is approximately $142 to $567 an ounce. Patients might not be financially able to purchase medical marijuana even in legal states.

Debbie Churgai is the executive director of Americans for Safe Access. This non-profit works to ensure legal and safe access to cannabis for research and therapeutic purposes. There are states where insurance covers the cost for a doctor’s visit and the cost for a marijuana card. However, insurance cannot cover the actual product costs.

There are two major issues that stand between Medicare coverage and medical marijuana. According to the Drug Enforcement Administration, the first issue is that marijuana is classified by the government as a Schedule I drug. This means that it has “no currently accepted medical uses and a high risk of abuse” in the United States.

Paul Armentano (deputy director of NORML), the National Association for the Reform of Marijuana Laws, stated that “there is no way the federal governments is going to reimburse people via a federal program for a drug they deem illegal.”

Medicare requires that FDA approve covered drugs as safe and effective. The FDA has approved three cannabis-derived drugs and one synthetic cannabis-related product for prescription use. However, it has not approved cannabis marketing for medical treatment.

Although marijuana is still illegal at the federal level, medical marijuana is legal in 37 states and Washington, D.C. Private insurers, such as those that offer Medicare Advantage, could cover it.

Kyle Jaeger (a senior editor at Marijuana Moment and a cannabis policy reporter) says that it is unlikely. Major health insurance companies will not cover cannabis, as long as it is a Schedule 1 drug under federal law. This is similar to banks that have resisted offering services to marijuana-related businesses.

Private insurers also rely on the FDA for guidance on what drugs they should cover. The FDA issued a January statement stating that current regulatory pathways were not sufficient to permit CBD to be classified as a dietary supplement.

Jaeger states, “It’s extremely frustrating for consumers because all they want to is a safe and consistent product.”

The market needs more information on cannabis’ medicinal use. “(Insurers), need data to prove that cannabis care outcomes are equal to, or better than, existing options that cover them,” Dr. Benjamin Caplan, chief medical officer at CED Clinic, which offers services to patients seeking cannabis treatment, says.

Partly this is complicated by the free market dispensary system, in which patients can buy any product they want. Caplan states that the system needs to be tweaked. “Patients cannot have free rein to purchase whatever they like, and insurance companies must cover it.”

Jaeger says that the road to legalization of cannabis is long, given the number of regulatory and legal obstacles faced, as well as the need for reform of the dispensary system. Jaeger says that it will take many years to have the conversation and make rules for something like Medicare span.