There are a number of reasons why plan sponsors are not providing coverage of medical marijuana in their benefits plan, says Lucian Schulte, senior vice-president and leader of the analytics team at Aon Risk Solutions health and benefits practice. Taking part in its panel discussion ‘In the Weeds: Should your benefit plan cover medical marijuana?’, he said some employers will cover it under certain circumstances such as cancer patients dealing with nausea and vomiting from chemotherapy. In some of these cases, they are doing so through health spending accounts (HSAs). However, many are taking a wait-and-see approach as concerns exist over prescribing practices which vary across the country and product variability. For example, the recommendation is that the THC content ‒ which produces the euphoria ‒ should not exceed nine per cent. However, many products on the market exceed this. This make it difficult to ensure doctors are comfortable with the products they are prescribing. Cost is another consideration as annual costs can be near $10,000. If a sponsor attempts to introduce a maximum spend, this poses problems if other drugs in the plan have unlimited coverage. Shoppers/Loblaws came to its decision to cover medical marijuana after its own in-depth clinical assessment, said Jonathan Tafler, senior director of product and operations, employer health solutions, at Shoppers. It found a body of evidence that medical marijuana was equally or more effective relative to its cost than other medicines. It also hopes that by providing medical marijuana it could see a reduction in opioid use. He said a number of studies show there is a reduction in opioid use, by up to 30 per cent, if marijuana is offered as an alternative. He said they believe this is an option. Coverage started in April of 2017 and came with a maximum benefit of $1,500. It is part of the core drug plan, but is a pay and submit product. Covering it under a health spending account, a popular option for plan sponsors, was decided against because there is no way for sponsors to track what strains and dosages are being used. So far, claims volume has been a lot lower than expected, he said. This could be due to their conservative approach, but also a lag effect that often follows new coverage in plans as members have to learn about it. Christine Than, a senior drug solutions consultant at Aon Risk Solutions, said marijuana has been used for centuries for variety of reasons including medical. Proponents of its medicinal value say it is effective for everything from depression to Parkinson’s disease. However, she said there is little scientific evidence of its medicinal properties and most of the evidence is anecdotal. However, it is conceded that it can help with spasticity related to MS, chronic pain, and nausea and vomiting in cancer patients undergoing chemotherapy. As well, the federal department of veteran affairs covers it as a treatment for PTSD (post-traumatic stress disorder) and it now has more than 1,700 claimants. This lack of strong scientific study, however, is why the medical community is slow to accept it, she said.
Courtesy of Benefits and Pensions Monitor website News Alerts