Imagine visiting your doctor and getting a prescription for a treatment that works, but there’s a catch – you can’t afford it.
If you’re a medical cannabis patient in Canada, you may be one of the thousands of people facing this problem, even if you have health insurance.
The fact is that most Canadians with health insurance don’t have medical cannabis covered. With the exception of veterans and people who have plans which include Healthcare Spending Accounts (HSAs), Canadians pay for their own medical cannabis, and these costs can be quite high.
Why Don’t Most Health Insurance Plans Cover Medical Cannabis in Canada?
Most insurance plans don’t cover medical cannabis because it doesn’t have a Drug Identification Number (DIN). Without a DIN, medical cannabis can’t be added to the list of drug formularies (drugs eligible for coverage) and therefore isn’t covered by default.
In order to be assigned a DIN, medical cannabis needs to be approved by Health Canada. Health Canada hasn’t approved it because there is a general lack of clinical research regarding its safety, effects, and active ingredients.
Until there’s more research about medical cannabis it won’t be covered by most health plans. Because it’s currently a Schedule II controlled substance, researchers have a harder time doing the necessary research. Fortunately, we’re already seeing more studies and can expect even more following legalization.
What You Can Do to Get Medical Cannabis Covered by Your Health Insurance
If you’re a medical cannabis patient with health insurance that doesn’t cover medical cannabis, there’s still a chance you can get it covered.
To be successful, your appeal for coverage needs to make a strong case for how medical cannabis will improve your condition. If your health improves, you won’t be as much of an expense in the long run and your plan provider will be more likely to approve coverage.
Follow these steps to maximize your chance of extending your health plan coverage to include medical cannabis. Note: If your health plan has a drug exemption or special claim process, follow those steps first.
Step 1 – Gather Evidence About Medical Cannabis Treatment
- Collect evidence to support the claim that medical cannabis will improve your condition.
- Outline your past treatments and how they’ve affected you.
- Gather evidence and examples of how medical cannabis can be an effective treatment for your condition.
- Ask your doctor for a letter of support indicating that he or she recommends medical cannabis for you. This letter will be a major asset.
Step 2 – Speak With Your Plan Provider/Administrator
- Request that your plan administrator/provider extends your health insurance coverage to include medical cannabis.
- Use the information and evidence you gathered to support your claim.
- Don’t contact the insurer directly. It’s the plan sponsor/administrator who must approve changes to coverage.
Step 3 – Get A Response And Overcome Obstacles
- If the sponsor/administrator responds with questions or objections, do your best to answer them with evidence which reinforces your claim.
- Just because you face objections doesn’t mean your request won’t be approved.
- Many people aren’t knowledgeable about medical cannabis. You may need to educate your plan sponsor and show them what you are actually seeking.
- You could provide a cost-benefit analysis of medical cannabis treatment to further support your request.
So there you have it – everything you need to know to get your health insurance to cover medical cannabis. Good luck, and remember to be patient and polite when dealing with your plan sponsor/administrator.