Even though the recreational use of marijuana has been legalized in Canada, there is still much debate about the status of the substance as a drug that ought to be prescribed for the medical treatment. Owing to confusions regarding the therapeutic value of marijuana and the simultaneous delays in passing legislation that would regulate the medical use of the herb, insurers all across Canada are hesitant about offering coverage for medical marijuana prescriptions.

Having to pay for a medical expense and being unable to acquire relevant coverage can often get overwhelming for patients.

We will elucidate factors that contribute to the reluctance of insurers when offering coverage for medical marijuana expenses. In addition to this analysis, we will also present:

  • A list of insurers that are extending coverage, detailing their insurance policies.
  • The organizations that have extended coverage to employees.
  • The therapeutic value of Marijuana.

In the hopes that it will facilitate greater access to medical marijuana and create avenues for best possible medical treatments that those in need deserve.

The Access to Cannabis for Medical Purposes Regulations

The approval of the Access to Cannabis for Medical Purposes regulations in 2016 was considered a milestone in the efforts to increase the use of marijuana as a valid treatment option for medical conditions. Canadian federal courts claimed that the Marijuana for Medical Purposes regulations were unreasonably restricting access to deserving patients and repealed the act that would be replaced by the ACMPR.

The ACMPR, among other regulations created room for easier access to medical marijuana such as:

  1. Allowing existing patients to buy marijuana from licensed dispensaries.
  2. Allowing patients to grow their own marijuana solely for medicinal purposes (subjected to a cultivation limit).
  3. Allowing patients to name another individual to grow marijuana for them.

For the full terms of the ACMPR with interpretations, you may visit this link.

According to studies conducted by the Canadian government, at the end of the first fiscal quarter for 2018-2019 there were a total of 330,000 registered clients for medical marijuana pharmacies. These numbers do not accurately reflect the actual demand for marijuana, since high marijuana prices discourage the use of the substance for many deserving patients and subsequent registration for the substance.

While there is a burgeoning need to increase access to marijuana and legislation aimed at increasing access has been introduced, the cost of buying marijuana acts as an obstacle to the treatment of many individuals. This burden could potentially be borne by insurers, however very few insurance companies are willing to extend coverage for marijuana prescriptions.

There are a fair number of reasons cited by insurers when refusing to extend coverage for marijuana prescriptions to clients, which can be broadly categorized into two basic reasons:

  1. The legal status of marijuana as a prescription drug
  2. The costs associated with offering coverage

Legal Complications

Marijuana has been in use for medical purposes since 1999. Despite this time span, the substance has yet to be classified with a Drug Identification Number (DIN). Once a pharmaceutical substance has been given a DIN, it can be marketed in Canada; it is illegal to market a medicinal drug without a DIN in Canada. The DIN serves as proof of the fact that the substance in question has been submitted to and passed a thorough review of its formulation, labelling and instructions of use and therefore fit for medical application. Since Marijuana has not yet been attributed a DIN it is technically not a prescription drug despite an increasing number of physicians prescribing it for treatment.

From an insurance company’s point of view, to extend medical coverage for a substance that has technically not been classified as fit for medical use is a violation of terms that dictate the services to be extended as part of a health plan. Insurance companies who extend coverage to medical marijuana, such as Sun Life, offer it as part of extended health plans that classify marijuana as medical equipment. For as long as Health Canada delays in attributing a DIN to marijuana, it is unlikely that many health insurers will offer coverage and unless a list of conditions is prepared that prescribe marijuana as a treatment method for specific medical conditions most insurers will offer coverage under very specific circumstances.

This does not in any way compromise the therapeutic value of marijuana however; Health Canada is currently working toward establishing medical marijuana as a prescription drug based on the standards set out by the Food and Drug Act.

High Financial Risk

The financial viability of offering coverage for medical marijuana also serves as a reason for why insurers are wary of extending services to marijuana prescriptions. Recent statistics developed by Health Canada on the prices of Marijuana point out that Medical Marijuana is relatively more expensive compared to other pharmaceutical alternatives.

Veteran Affairs Canada had been covering up to 10 grams per day of medical marijuana for its clients since 2008 with no limits on the price or medical conditions. In response the costs surged to $63.7 million by March 2017 as compared to $19,088 in 2008, at which point the group had to cut coverage to 3 grams a day at $8.50 a gram.

The reduction in costs did not reflect the degree to which coverage was reduced, with costs just going down to $51 million by March 2018. This might serve as an indicator that perhaps more coverage needs to be offered to reduce the cost burdens on existing insurers however, it is a combination of legal and medical uncertainty that create barriers which hinder the creation of medical marijuana insurance market.

When considering the costs relative to pharmaceutical alternatives, medical marijuana can cost almost 4 times as high as other medications. Sometimes it is just cheaper for insurance providers to not cover medical marijuana.

It needs to be understood that most of the concerns that insurance providers have, stem from structural deficiencies in the medical marijuana industry. The absence of price controls, standards for professional practice for health care practitioners and regulations that would dictate the use of medical marijuana causes much unease and poses significant financial risks that are at the root of the lack of provision of insurance coverage for medical marijuana. This calls for a need to petition for greater market controls that will go a long way in increasing accessing to marijuana.

Insurance Coverage for Medical Cannabis

Despite the costs and legal complications associated with insurance coverage for medical cannabis, there are some Canadian insurers who have chosen to offer coverage as part of group benefits or individual benefits plans. A few insurers have health spending accounts that could potentially be used to cover expenses associated with medical cannabis.

It must be noted that it is not the case that your insurer must offer a medical cannabis coverage plan; it is possible to convince them to make an exception for your individual case based on evidence pointing to the medical necessity of cannabis for your condition.

There are legal precedents where clients have taken their insurance companies to court and secured coverage for their medical cannabis such as: Jonathan Zaid at the University Of Waterloo and it is possible for employers to convince their insurance providers to develop group benefits plans as in the case of Loblaw and shoppers drug mart.

It is rather difficult to find entities that would cover medical cannabis as part of their benefits plans, owing to the fact that there are few of them around and some of them are not technically insurers. We use the term entities because the following list includes insurance companies, labour unions and organizations that offer coverage. This includes:

  1. Sun life Financial
  2. Veterans’ Affairs Canada
  3. Manulife
  4. Markers Insurance
  5. Alberta Blue cross
  6. Medreleaf
  7. Ontario Public Service Employees Union
  8. Labour International Union of North America
  9. Employee Health Care Spending Accounts

Each of these entities has specific coverage or discount plans that could assist in covering the costs of your medical cannabis. We attempted to create an exhaustive list of entities that would assist in covering your treatment expenses, rather than just restrict it to insurance companies to incorporate all the possible ways in which you could relieve your burdens.

We shall now offer background information and some of the features of the coverage plans created by each of the companies.

Sun Life Financial

Sun Life Financial is the first insurance provider that came out with insurance coverage for medical cannabis. It is based on the efforts of the company that have infused hope that many others will follow in its footsteps.

Sun Life Insurance initiated a group benefits plan in early 2018. It was developed to overcome the spending limits imposed by employee Health Care Spending Accounts that either did not outright cover medical cannabis or limited expenses on medical cannabis to the extent that employees could buy inadequate amounts of the drug.

Sun Life Insurance claims to have created Extended Health Care plans that offer comprehensive coverage in terms of the conditions that Sun Life will cover and greater regulation of the conditions for which medical cannabis can be covered. This includes setting negotiable spending levels integrated in the Extended Health Care plans in case of a seriously ill employee or to monitor the spending on medical cannabis such that the privileges as bestowed by employers are not abused.

The Sun Life Financial insurance policy does not cover individual benefits; the company only offers group insurance plans for employers. This is an optional coverage plan that covers the following conditions and specifications:

  1. Cancer: With severe or refractory pain; or with nausea or vomiting associated with cancer treatments
  2. Multiple Sclerosis: With neuropathic pain or spasticity
  3. Rheumatoid Arthritis: With pain that failed to respond to standard Therapy
  4. HIV/AIDS: with anorexia; or with neuropathic pain
  5. Individuals requiring palliative care.

For this policy to be applicable to employees, they must submit a prior approval form for medical cannabis. It is only after a review and meeting the clinical criteria that employees and their dependents are offered medical coverage for cannabis. The cannabis may only be purchased from licensed Health Canada producers of cannabis as per the requirements set out in the Access to Cannabis For Medical Purposes Regulations.

For information on how to reach Sun Life Financial representatives, you may go through this link. This lists contacts for representatives throughout Canada present at Sunlife Financial offices.

Manulife

As of September 2018, Manulife began offering group benefits plans for medical marijuana to employers. This plan is not covered under standard health plans since marijuana has yet to be issued a Drug Identification Number (DIN) or a Natural Product Number (NPN) and therefore has to be specifically opted for. The official name for the policy is the Medical Marijuana Program.

Manulife has made it clear that insurance claims can also be made under a Health Care Spending Account (HCSA) since spending under an HCSA is not restricted to substances having been issued a DIN or NPN. In order to eligible for coverage under an HCSA, Manulife requires the beneficiaries to follow comply with the following regulations:

  • The medical marijuana must be bought according to the Access to Cannabis for Medical Purposes Regulation.
  • The member must provide a copy of the Authorization to Possess Marijuana for Medical Purposes.

Manulife’s Medical Marijuana Program, includes a broad range of support measures for cannabis patients that are not included in other coverage plans for medical marijuana. More specifically, the plan includes:

  • Member referral to specially trained pharmacists at the Shoppers Drug Mart Patient Care.
  • Help with the co-ordination of medical marijuana distribution.
  • Case Management, which includes patient oversight and outreach.

These measures ensure that Manulife monitors the progress of your condition and takes responsibility for consultation that could prove immensely beneficial for the treatment. Manulife is also currently developing an online billing system, so that members of the plan do not have to pay for expenses covered in the plan upfront.

A formal application may be submitted through the sponsor to get coverage from the Manulife Medical Marijuana Program. The program incorporates claims control and case management to regulate the issuance of policy to members. The conditions that Manulife covers as part of the program include:

  • Stiffness and involuntary spasms in people suffering from multiple sclerosis.
  • Nausea and vomiting in people undergoing chemotherapy.
  • Chronic Neuropathic Pain.

Before approval for coverage, the member in question and their doctor will be required to submit information regarding their conditions that require the use of cannabis and treatment history. Upon submitting the information to a thorough clinical review, decisions will be made regarding the eligibility of the claim. Once approved, members will be extended the privileges of the Medical Marijuana Program.

The coverage plan includes ongoing case management, education, side-effect management, adherence management, counselling and email as well as phone support. The consultation and support programs shall be conducted by Shoppers Drug Mart patient care center. The coverage limits are negotiable as per member needs, as specified by the sponsor.

You can reach out to Manulife insurance representatives through this link.

Veteran’s Affairs Canada

Veteran’s Affairs Canada developed a reimbursement policy for medical marijuana in 2008 with no restrictions on spending or medical conditions. By 2017, coverage costs had risen to $63.7 Million, at which point the policy was limited to spending $8.50 a gram and 3 grams daily.

The VAC offers coverage to members subjected to screening procedures and in compliance with regulations as set out by Health Canada’s Cannabis regulations. The eligibility criteria as specified by the organization are:

  1. Veterans who have qualified for the disability award or the VAC disability pension.
  2. Some veterans may be reimbursed for cannabis even if they have not been qualified for disability pensions, if and only if the treatment is not available in their region and they qualify for health care programs under the VAC.

The above mentioned conditions are regulated based on the treatment of a pensioned or awarded condition policy and the policy on the eligibility of health care programs.

Each of these policies outline the conditions under which veterans can apply for coverage for medical cannabis, the entire policy statements can be read here and here. For the benefit of the reader, we shall present some of the more salient parts of the policies as they would apply to the case of medical cannabis. When deciding on whether a member ought to receive benefits, the guiding principles are:

  1. The requested treatment is expected to produce a positive outcome for the condition
  2. The requested treatment appropriately addresses the symptoms produced by the condition for which treatment is requested.

The specific conditions as set out by the VAC for the reimbursement policy to apply include:

  1. All medical Cannabit be bought from a federal licensed dealer of Marijuana.
  2. Beneficiaries must present a medical authorization certificate to qualify for benefits.
  3. Veterans’ shall not be reimbursed for purchases made from provincial cannabis retailers.
  4. Veterans’ Affairs Canada will reimburse travel expenses incurred in the process of seeking authorization for medical cannabis if a local physician does not provide authorization.
  5. Veterans’ Affairs Canada will review all applications for medical cannabis on a case-by-case basis. Until approval has been given, applicants will not be reimbursed.
  6. Veterans’ Affairs Canada requires members to get approval from the following specialists for respective conditions:
    1. Neurologists for Neurological conditions
    2. Oncologists for Cancer
    3. Psychiatrists for Mental Health
    4. Pain specialists for Pain management

Individuals who are seeking reimbursement for medical cannabis are required to get approval from these specialists, depending upon the condition they are seeking medical cannabis for.

  1. The authorization from a medical specialist is valid for a period of 2 years before it expires.
  2. Veteran’s Affairs Canada does not restrict coverage to just veterans, it is possible for civilians and personnel of the Royal Canadian Mounted Police may also apply for reimbursement.

For more information on the reimbursement policy presented by Veteran’s affairs Canada, you can visit their website here.

Medreleaf

Medreleaf is a subsidiary of Aurora Cannabis that serves as a think tank for medical research in Canada. If you are living on a low-income government subsidy programs, medreleaf offers a flat 25% discount on all their Cannabis products.

The low income government subsidy programs that medreleaf works in association with are:

Federal Programs:

  1. Canadian Pension Plan- Disability Benefits
  2. Guaranteed Income Support
  3. Old Age security
  4. War Veteran’s Allowance.

Provincial Programs

  1. Alberta Seniors Benefits
  2. Assistance for children with Severe Disabilities
  3. Assured Income for Severely Handicapped
  4. Commission de la santé et de la sécurité du travail– Permanent
  5. Employment and Assistance for persons with disabilities
  6. Employment Insurance-Sickness Benefits
  7. Long Term Disability Program- Private Insurer
  8. Ontario Disability Support Program
  9. Ontario Guaranteed Annual Income Support Program
  10. Provincial “Works” or Employment Assistance Programs
  11. Quebec Social Solidarity Program
  12. Registration with Disability Support Services through your educational institution
  13. Saskatchewan Assured Income for Disability (SAID)
  14. WSIB – Permanent Disability Benefits
  15. Manitoba 55 Plus Program
  16. Other provincial or territorial income or social assistance programs.

In order to qualify for the medreleaf, it is mandatory for applicants to be receiving assistance from one of these benefits programs. They must then fill out this form, to be submitted to Medreleaf.

The Medreleaf team will evaluate the applications on a case by case basis and then inform successful applicants of their enrollment into the program.

Ontario Public Service Employees Union

As of June, 2017 the Ontario Public Service Employees Union started offering its members up to $3,000 worth of medical Marijuana coverage. The OPSEU does not put any restrictions based on illness and chooses to treat the medical cannabis as any other medication.

Because the organization runs its own benefits plans and does not rely on any external insurance provider, it sets its own regulations on how to give out benefits to the members. Currently 130,000 members of the OPSEU are under coverage for medical marijuana.

Labourers International Union of North America

The Labourer’s International Union of North America has also introduced a medical marijuana coverage to its members. This coverage has been extended in an attempt to curb the increased use of opioid in medical treatments.

LIUNA offers coverage for Cannabis due to the therapeutic value of the substance and only extends coverage to retirees, disabled workers and dependents. LIUNA local 625, the only LIUNA sub-division that is offering the medical marijuana benefit represents 1500 construction workers and 1600 dependents in the Windsor Area.

The coverage plan has been designed keeping in mind the health and safety considerations that regulate the use of cannabis in the workplace. According to reports from LIUNA officials, those individuals who are covered by LIUNA and are not actively engaged in the workplace (i.e. retirees, disabled employees and dependents) will have coverage for all the cannabis based products that they might require. However, those who are actively engaged in the workplace shall only be given access to cannabis oil, since the absence of THC in the substance does not render the user cognitively impaired.

You may contact LIUNA 625 business manager Rob Petroni at: 519-564-9522 or email: rpetroni@liuna625.ca.

Blue Cross Plans

Blue Cross Plans are a collection of non-profit benefits carriers that work across the Canada. The sub-organizations of blue cross plans can be divided into five categories by geographical area based on provincial divisions:

  1. The Alberta Blue Cross: Covers Alberta and the Northwestern Territories
  2. The Medavie Blue Cross: Covering New Brunswick, New Foundland, Nova Scotia, Quebec and Prince Edward Island.
  3. The Manitoba Blue Cross: Covering Manitoba and Nunavut.
  4. The Pacific Blue Cross: Covering British Columbia and Yukon.
  5. The Saskatchewan Blue Cross: Covering Saskatchewan.

The Manitoba Blue Cross, The Pacific Blue Cross and the Saskatchewan Blue Cross do not offer coverage for Medical Marijuana, however the Medavie and Alberta Blue Cross do. Most areas in Canada are covered by blue cross foundation with the exception of British Columbia, Yukon, Manitoba, Nunavut and Saskatchewan.

Alberta Blue Cross

The Alberta Blue Cross offers group benefits plans to employers. Upon being offered coverage under the plan by an employer, the beneficiaries are signed up for an Employees Health Spending Account under which they can file claims for medical marijuana.

Alberta Blue Cross does not specify conditions under which coverage members will qualify for medical marijuana benefits, leaving the regulation of the coverage plan to be decided during negotiations with your employer.

If you work for an organization that is covered by the Alberta Blue Cross, you may ask your employer to provide coverage for medical marijuana and the conditions under which the plan ought to be applicable to you.

The Alberta Blue Cross asks beneficiaries to comply with all the stipulations for the Access to Cannabis for Medical Purposes regulations such as:

  1. The cannabis must be bought from a licensed dealer
  2. The members of the plan must have an authorization form.

Further regulations include:

  1. Members may be asked to submit a history of medical conditions and treatments.
  2. Provide evidence from a doctor stating that the condition will in fact be effectively treated by the use of marijuana.

The rules that apply to coverage for medical cannabis/marijuana are the same as those that apply to health care plans that dictate the functioning of Health Spending Accounts.

To contact a representative of the Alberta Blue Cross, please visit this link. The Alberta Blue Cross has offices in Edmonton, Calgary, Grande Prairie, Lethbridge, Medicine Hat and Red Deer.

 

Medavie Blue Cross:

As of October 2018, the Medavie Blue Cross introduced a new Extended Health Care benefits plan that would cover expenses related to the procurement of medical marijuana. The plan is a group coverage plan for sponsors.

The plan takes the form of a reimbursement scheme for the purchase of:

  • Fresh and Dried Cannabis
  • Cannabis Oil

The Medavie Blue Cross does not offer coverage for any other cannabis based products. The sponsors are presented with multiple benefit schemes that they can implement, assuming that they have opted to cover employees for medical cannabis.

To qualify for reimbursement, members must submit authorization for use and possession of medical marijuana as stipulated by the clauses of the Access to Cannabis for Medical Purposes regulation. Members and sponsors also have to fill out this form to qualify for medical cannabis reimbursement.

The coverage is offered for the following conditions:

  • Chronic Neuropathic Pain
  • Refractory pain in palliative cancer
  • Nausea and Vomiting due to Chemotherapy
  • Spasticity in multiple sclerosis or spinal cord injury.

You may ask your sponsor to speak to Medavie Blue Cross sales representatives to avail the reimbursement benefits from the Medavie Blue Cross Extended Health Care Benefits plans. For information on how to reach out to representatives you may visit this link.

The Medavie Blue Cross has offices in Ontario, Quebec New Brunswick, New Foundland & Labrador and Nova Scotia; for addresses to each of these offices, you may visit this link.

Markers Insurance

Markers Insurance is a subsidy of the Evergreen Pacific Insurance Corporation. The company was set up in association with Alternative Health Association of Canada as agent and financial sponsor.

As compared to other insurance plan providers who only offered cannabis coverage as part of group benefits programs, Markers Insurance intends to launch individual coverage plans along with employer sponsored group benefits.

Initially announced to be launched in August 2018, the launch was postponed to October 2018 and is expected to be presented very soon.

For more information or to get in touch with Markers Insurance you may visit this link.

The legality of coverage: Why and How?

People seeking out coverage for medical marijuana should also note that it is not illegal to provide medical marijuana insurance and you can always ask your coverage provider or employer to offer coverage. If your sponsor or insurance company does not have plans, it is still possible to create specialized plans for your coverage. It is more a concern of complying with company policy, rather than a legal concern and as such can be changed in certain circumstances.

There is legal precedent for how individuals sought out and won coverage for medical cannabis after legal battles with their service providers. This document discusses the legality and procedure to be followed before asking for coverage of medical marijuana. We will discuss some parts relevant to reader and discuss the occasions where legal precedent was set for the extension of medical marijuana; we encourage you to read the document yourself.

It must be noted that the document was written before the legalization of the recreational use of marijuana, but since the use of marijuana or cannabis has been legal since 1999 it still applies today because the obstacles to getting coverage still exist.

Getting a Prescription

The Access to Cannabis for Medical Purposes Regulations (ACMPR) clearly state that people may possess fresh or dried marijuana or cannabis oil if they carry it for medical use. It is important that the marijuana/cannabis has been purchased from:

  • A licensed producer
  • A Health Care practitioner in the course of treatment for a medical condition
  • A hospital.

The ACMPR defines a “Health Care Practitioner” as a “medical practitioner”, which means a licensed physician or a nurse practitioner.

The ACMPR has also set out the conditions for what qualifies as a valid prescription. The ACMPR states that the prescription must contain the following pieces of information:

  • The practitioner’s name, surname, profession, business address and telephone number, the province in which they are authorized to practice their profession and the number assigned by the province to the authorization and if applicable, their fax and email address
  • The patient’s given name, surname and date of birth.
  • The address of the location at which the patient consulted with the practitioner
  • The daily quantity of dried marijuana, expressed in grams, that the practitioner authorized for the person
  • The period of use.

Once a prescription containing the above mentioned information has been created, it needs to be ensured that standard medical practice for diagnosing a condition that qualifies for medical cannabis treatment has been followed. The College of Physicians and Surgeons of Ontario (CPSO) has specified the expectations that have to be met before a diagnose calling for the use of marijuana is made, you can read the full document here. Some of the relevant points of the policy are:

  1. “As with any treatment, physicians are not obliged to prescribe marijuana if they do not believe it is clinically appropriate for the patient.”
  2. “Given the potentially severe nature of these risks, physicians must not prescribe marijuana to patients under the age of 25 unless allother conventional therapeutic options have been attempted and have failed to alleviate the patient’s symptoms.”
  3. “In keeping with these obligations, physicians prescribe marijuana must advise patients about the material risk and benefits of marijuana, including its effects and interactions, material side effects, contra indications, precautions and any other information pertinent to use.”
  4. “As with any drug, the physician who prescribes marijuana must monitor patients for any emerging risks or complications. Prescribing must be discontinued where marijuana fails to meet the physicians’ therapeutic goals or the risks outweigh the benefits”

Assuming these criteria have been met, then the prescription for marijuana/cannabis is a valid prescription that is backed by thorough compliance with standard of prescription. To be clearer, each of these conditions set out by the CPSO mean:

  1. Doctors must not prescribe marijuana if they do not believe that it will help treat the patient’s condition.
  2. Marijuana cannot be prescribed to people younger than 25. If and only if no other treatment strategy has helped a patient younger than 25, then doctors may prescribe medical marijuana to the patient despite the age limit.
  3. The doctors must inform their patients of:
    1. The risks and advantages of using marijuana
    2. The Effects of the substance and if it interacts with other medication or substances
  4. The doctors must monitor and evaluate the patient as the treatment continues to ensure that there are no risks or complications that come from using marijuana for treatment. If doctors do identify a risk then they must stop prescribing marijuana.

Every province in Canada has a separate governing authority that has set out the standard operating procedure for prescribing marijuana for medical purposes. The links to the guidelines some of the bodies have set are given below:

College of Physicians and Surgeons of Newfoundland and Labrador: Advisory and Interim Guidelines

College of Physicians and Surgeons of Alberta: Standard of Practice

College of Physicians and Surgeons of British Columbia: Practice Standard

College of Physicians and Surgeons of Manitoba: Standards of Practice of Medicine

Assuming that you are not in Ontario, but instead in another province of Canada, you can refer to the standard of practice relating to the prescription of marijuana to ensure that your prescription is valid.

Coverage of costs of obtaining medical marijuana or cannabis

This section covers the various conditions under which individuals can seek out insurance coverage for medical marijuana under either state sanctioned health plans or private insurance plans as set out in group or individual benefits plans.

Extended Health Care Policies

Access to health benefits through sponsored coverage or individual plan does not depend on whether someone has had an accident. These policies apply to anyone who has a private insurance plan.

Most companies do not offer coverage for medical marijuana since marijuana has not been assigned a drug identification number despite having been legalized.

Back in 2015 a student at the University of Waterloo petitioned for coverage to treat a condition called New Daily Persistent Headache. He argued that using cannabis helped him concentrate long enough to sustain his academic well being. The university agreed to extend coverage to him, by asking for special consideration from Sun Life Financial; the insurer for the University.

Similarly Manulife currently insures Loblaw Companies Limited and Shoppers drug mart, covering expenditure of up to $1500 a year for employees who may require medical cannabis for their treatments.

Coverage under Accident Benefits

If you get into an accident it is possible to get reimbursement under the heading of “medical benefits”.  According to the Statutory of Accidents Benefits Schedules in Ontario states that the medical benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for:

  • Medication
  • Other goods of a medical or rehabilitative nature that the insurer agrees are essential for the treatment of the insured person, and for which benefit is not otherwise provided in this regulation.

Now, every state has its own schedule of accident benefits that can be referred to when seeking out medical coverage for the costs of marijuana to treat any trauma that you might have face as a result of an accident.

When going to ask for reimbursement or coverage for the costs of medical or rehabilitation drugs; such as medical marijuana for the treatment of trauma inflicted in an accident, people must to their insurance provider a Treatment and Assessment Plan. This allows the insurance provider to review the application and the cost with the treatment, the insurer can choose to approve or deny the claim within the timeline specified by the Accidents Benefits Schedules.

This does not necessarily apply to medications, according to the Statutory of Accidents Benefits Schedule in Ontario, an insurer is liable to pay for an expense on medical or rehabilitation benefit if the expense was reasonable and necessary as a result of the injury the beneficiary experienced for “drugs prescribed by a regulated health professional”. A regulated health professional is a licensed doctor.

These injunctions were introduced in light of the fact that the delay of medication presents serious risks and the fact that it is entirely possible that an insurance adjuster may know nothing about the therapeutic value of the marijuana coverage for which is being claimed.

In order to attain coverage for medical marijuana in such a condition is easily managed under the ACMPR. The individual seeking out coverage needs to fill out an application for expense and submit the application. The legal precedent for the success of these claims includes cases like:

Doyon vs Allstate Insurance

After getting into a motor vehicle accident in 2009, Ms Doyon experienced onset of chronic pain and depression. Medical Marijuana was prescribed by her chronic pain specialist and her physician testified that Ms Doyon’s condition had significantly improved since the use of medical marijuana began.

Given the higher potency of the marijuana Ms Doyon procured, which were not Health Canada approved, as well as the significantly low costs of the marijuana, her claims were deemed reasonable by courts and she was awarded coverage.

Ultimately, it needs to be understood that in order for you to qualify for the coverage of medical marijuana, your claims for coverage for your expenses need to be deemed reasonable. As long as those of you seeking out coverage for medical marijuana as part of your extended health care plans or after getting into an accident, it is possible to convince your employer or your insurance provider to provide coverage.

As long as all the legalities involved in the process of procuring and possess medical marijuana are met, there should be no problem in acquiring coverage. When going to get authorization to possess and use marijuana/cannabis for medical purposes please insure that you are complying with all the regulations included in the Access to Cannabis for Medical Purposes and the prescription standards set out by the body governing medical practice in your province.

The use of medical marijuana has been proven to be extremely effective for a wide range of conditions, if your primary physician is convinced that the use of marijuana will benefit your condition as well then, your insurer has no reason to not cover your insurance.

It is expected that in the coming years, many new insurers that cover medical marijuana will come up with group or individual plans. It is only a matter of time before coverage becomes common, as soon as all the legalities and medical considerations associated with medical marijuana have been resolved. If you wish to contribute, you can begin by actively assisting in the research efforts to prove the therapeutic value of marijuana and push for active governance to increase the accessibility to marijuana through state sponsored insurance plans or making coverage for medical cannabis a part of standard health care plans.

Restating the medical benefits of marijuana

Health care is central to the well being of all society. To create systems that can effectively treat the illnesses and conditions that are prevalent is very important. The sheer number of people who, at some point in their lives, suffer from a serious condition requires health care systems to work efficiently and get as many people back on their feet as possible.

The problem with this efficiency is a reliance on a symptom-oriented approach and chemical medications that seek to treat the symptoms without consideration for the impact on the individual body. Especially for conditions such as HIV/AIDS and cancer, the treatment methods are often invasive and as destructive to the body as the condition itself. The use of marijuana in conjunction with conventional treatment method can prove to be beneficial in more than just the physical sense.

When a loved one falls victim to a severe illness their agony is difficult to witness. It is clear that disease is not just “physical”, there are psychological impacts that come from a fear of a relapse and the pain that one goes through. It is not the case that the use of marijuana is at odds with a symptomatic approach, but marijuana is capable of relieving much of the stress and anxiety associated with many illnesses and their treatment methods.

As earlier identified, the lack of coverage for medical marijuana comes from policy shortcomings in the regulation of medical marijuana. Market control and speeding up the process of developing regulations that govern the use of medical marijuana is only going to help improve the capabilities of health care systems in terms of providing holistic health care that caters to both the physical and the psychological aspects of illnesses.

It could be the case that much of the reluctance comes from a place of misunderstanding about the potential medical applicability of marijuana as a treatment method.  Canacall has always held firm to the belief that marijuana has far more therapeutic value when used medicinally, rather than when used recreationally. There is ample evidence that indicates that marijuana should be made a part of conventional treatments of illnesses wherever applicable so that treatment methods are far more effective than the usual methods of symptomatic treatments of illnesses, in the physical sense, and not considering the psychological effects of it.

Just to make the point clear, we would like to restate the benefits of using marijuana by taking into account the physical and psychological impact of the use of the substance, while also highlighting the need to restrict the use of marijuana to medicinal use over recreational use.

The Psychological Benefits Of Marijuana Use

Mood disorders are one of the most prevalent psychological conditions in the world as well as Canada. According to a study by the government of Canada, as of 2010 a total of 10% of the entire Canadian population consulted a mental health professional for a mood disorder. This is the number of reported cases; the numbers may have been higher given the obstacles created due to the social perceptions of seeking psychological therapy or the obstacles to seeking out psychological counselling, even though people were suffering from a disease.

These numbers have only increased over the years; this draws attention towards the need to develop better treatment options and increasing the accessibility of treatment to those that are suffering from mood disorders. It is a known fact that managing the precursors of mood disorders and other psychological conditions is far more effective than direct intervention when someone develops a certain condition. Prevention is better than curing the condition.

The use of pharmaceutical drugs to treat those with psychological conditions is the cause of much concern amongst patients. The impact of medications that directly affects the balance of neurotransmitters in the brain is known to cause damage in terms of the quality of life, aggravating symptoms and some use to treat conditions like insomnia (such as opioid-based medications) often risk addiction, withdrawal and in some cases a fatal overdose.

While clinically tested to be beneficial, the control of these medications is important to prevent damage inflicted by these drugs. We feel that this might also hold true of medical marijuana/cannabis while at the same time averting the risks associated with using other pharmaceutical methods of treating the psychological disorders.

According to the Canadian Mental Health association, the following facts and figures hold true about the state of mental disorders in the country:

  1. 1 in 5 adults will experience mental health problems.
  2. 8% of all adults develop major depression at some point in their lives.
  3. Approximately 1% of all adults will develop bipolar disorder.
  4. By 40 years old almost 50% of all the adult population in Canada will have developed a mental health problem.
  5. The prevalence of schizophrenia is 1%.
  6. The prevalence of anxiety disorders per household is 5%.
  7. Only 1 in 5 children in Canada receive mental health care.
  8. Mental disorders are the second highest hospital expenditure in Canada, after injuries, among the youth of the country.

We will now discuss the value of marijuana in the treatment of specific psychological conditions and suggest, based on research, which conditions will not be helped with the use of medical marijuana.

Anxiety

There is ample amount of research data that supports the use of CBD products to treat anxiety and other stress-related symptoms. It is a commonly acknowledged fact that in the absence of THC (the substance that induces the state of intoxication when cannabis is used) gives cannabis much of its healing characteristics, since it does not alter a person’s conscious state in any way.

A study conducted on the role of cannabinoids (CBDs) in the Recent Patents on CNS Drug Discovery explored the future of cannabis in the developing new and more effective treatments for anxiety.

The study concluded that cannabis conclusively showed a reduction in anxiety symptoms and the causes of anxiety when the test subjects were exposed to situations where anxiety was previously observed. Research still needs to be conducted on how exactly cannabis achieves its anxiety reducing effects, i.e. what parts of the brain and what neurotransmitters does cannabis affect, yet the value of CBD as a potential treatment option was clearly established.

The study also took into account the potential for abuse and addiction when cannabis was used as a treatment for anxiety symptoms, by lowering the doses of CBD administered to the patients. It was concluded that if the drug administration is regulated as per the patient’s requirement the risks of developing addiction or experiencing withdrawal were significantly reduced without reducing the healing effect of cannabis.

A study aimed at trying to understand the paths cannabinoids took in achieving their effects on animals with similar brain structures as the human brain, concluded that cannabis did induce anti-depression and anti-anxiety effects. It was observed that cannabis can achieve these effects because it did not allow the activation of certain neuroreceptors (areas of the brain responding to and regulating the effects of neurotransmitters) that are central to the experience of anxiety and depression. The researchers concluded that the cannabinoids in the cannabis reacted far better with the neuroreceptors as compared to other treatment options for anxiety.

‘Harm Avoidance’ has been associated with the experience of anxiety symptoms in many people.  One of the key cognitive components observed in individuals who have anxiety, is hypersensitivity to environmental factors. People who have anxiety or are likely to develop anxiety often exhibit mental processes that point towards a skewed understanding of the risk involved in any activity, this perception of the risk leads to increased inhibition and a sense of unease when people are exposed to certain situations.

Due to these factors, people tend to increasingly avoid engaging in activities or actions that are posing the risk to them; the translation of an increased sense of risk and the resulting lack of action is termed as ‘Harm Avoidance’. This is a cognitive bias that reinforces beliefs about the world that only aggravate anxiety and one that is easily remedied through the use of marijuana. Marijuana is known to induce euphoria and reduce harm avoidance in individuals which then reduces the anxiety associated with taking action.

Cannabis has also been observed as producing far fewer side effects as compared to the medication used to treat anxiety. Recent research in the role of using measured doses of cannabis as a treatment method have also successfully identified the dosage that would prove to be the most effective.

This particular research study was aimed at developing a review of a large body of information on the therapeutic value of marijuana; it was concluded that many studies have pointed towards using small and regulated dosages as an effective treatment method that does not have a sedative effect on patients while inducing very little pro-anxiety effects on them. In addition to these healing effects, it has also been observed that the use of cannabis also has an excellent safety profile since it does not pose high risks of overdose and addiction.

Depression

Depression is the second most prevalent psychological condition in Canada. There are many similarities between depression in anxiety, sometimes patients exhibit depression with anxiety that requires a multi-disciplinary approach to the condition. The use of marijuana to treat these conditions, without the need to prescribe medication that would treat symptoms separately, reduces the risk of aggravating the condition as the medications interact with each other.

Just as the case with anxiety, the use of cannabis to treat depression has much therapeutic potential. The presence of THC and other cannabinoids has been observed to render anti-depressant effects in those suffering from depression.

There is a rather wide range of reasons that may cause the onset of depression, from biological precursors such as genetics, malfunction of the brain that causes neurotransmitter imbalance. The use of anti-depressants that counter the insomnia and the mood effects of depression (usually opioid based) often pose the risk of addiction, withdrawal and sometimes fatal overdose.

It is possible to develop treatment methodologies that incorporate medicinal marijuana to overcome the risks that usually show up when conventional methods of treatment are employed without compromising the effectiveness of the treatment in question.

There is an increasing amount of research that is pointing out the anti-inflammatory effects of CBD, due to the presence of anti oxidants and the anti-anxiety effects that it has. By increasing the neurotransmitters (serotonin and dopamine) which those who have been diagnosed with depressive disorders are deficient in, these cannabinoids present in marijuana manage to allow management of the conditions as the patients continue psychological counselling can prove an effective strategy to counter depressive disorders.

Although there is plenty of research that corroborates the claims about the therapeutic value of cannabis/marijuana when treating mood disorders, there are reasons to believe that the use of marijuana for schizophrenia, bipolar disorder or personality disorders is not as effective.

Psychological conditions that involve psychosis whether in the form of hallucinations or delusions might potentially be aggravated due to the chemical reactions of cannabinoids with neurotransmitters. What serves as a medicinal tool may become harmful if the use is not clearly regulated and comprehensive strategies not developed that suggest the optimal treatment paths while including marijuana as an integral component.

The stress- and anxiety-relieving attributes of medical marijuana is apparent and when used in conjunction to treatments for non-psychological conditions could serve as an effective tool to manage anxiety and depression observed in those with chronic and potentially terminal illnesses.

If such a treatment plan is developed, it would significantly improve the quality of life of those who have contracted these illnesses and are going through difficult times emotionally-speaking, as a result of their illnesses.

Biological Benefits

Many people already understand that the use of marijuana causes a sense of euphoria and is “fun”. This directly speaks of the benefits of using marijuana as part of treatments for psychological conditions; however there also exists research that points out the physical benefits of using marijuana as a means of treating and managing the symptoms of conditions like epilepsy, HIV/AIDS, cancer and glaucoma.

Marijuana achieves these effects because of its unique chemical properties of being an anti-oxidant. Many of the conditions that we have mentioned before can be aggravated or caused by what is called ‘oxidation stress’. Oxidation stress is caused by inflammation in the body because of increased irritation or stress in the body. Oxidation stress may cause any number of conditions such as headaches, chronic pain, epilepsy and seizures the use of antioxidants helps relieve the symptoms of these conditions as the body anti-oxidizes in response to the use of antioxidants.

Neurodegenerative conditions like Alzheimer’s, Parkinson’s disease, dementia and epilepsy are attributed to the inflammation of nerve endings. This inflammation is commonly attributed to the oxidation stress experienced by neural pathways which causes dysfunctions in the central nervous system. The use of marijuana to reduce the inflammation in nerve endings helps to slow down the progression of neurodegenerative conditions (Parkinson’s and Alzheimer’s) by reducing the oxidation damage done to the nervous system. Marijuana has also been shown to reduce the frequency and the intensity of the seizures experienced by epilepsy patients.

Marijuana also has analgesic properties that allow it to serve as a way to manage pain associated with chemotherapy and chronic joint pain. Cancer patients who are undergoing chemotherapy often report nausea, joint pain, stomach cramps, insomnia and loss of appetite. The regulated use of marijuana has been shown to reduce the pain associated with chemotherapy, has improved sleeping times of chemotherapy subjects and has been reported to improve the appetites to allow patients to maintain health through nutritious diets.  Similar impacts have also been observed by those diagnosed with HIV/AIDS.

Given both the physical and the mental benefits of using marijuana, it is possible to develop a holistic approach towards disease control and patient management by incorporating marijuana in treatment methodology. Fact of the matter is, marijuana is medication that can be used to achieve a broad range of treatment goals far more effectively and efficiently than other types of treatment.

There is a need to conduct more research on the subject in order to truly establish the medicinal value of the drug and it is only a matter of time before it gets established as such. If insurance coverage truly is restricted by the lack of clinical evidence and policy implications, given the ample evidence that points towards a greater use of marijuana in health care; quite soon it will be less difficult to get coverage.

Health care institutions, practitioners and those who are considering the use of marijuana to manage their conditions need to understand the importance of including marijuana in treatment strategies. The sooner it is appreciated that rehabilitation efforts through the use of marijuana will become far more effective than they currently are, the sooner it is that more insurance providers make marijuana a part of their standard health care plans and more insurers will follow suit. Until such a point comes, many deserving people will fail to receive the health care that they have a right to.

Recreational Use of Marijuana

The legalization of the recreational use of marijuana poses a direct conflict with the regulated accessibility of marijuana for medical use. While marijuana has significant medical benefits, it still does not change the fact that as with any other type of medication, the use needs to be monitored such that it can achieve its therapeutic effect.

There is significant reason to believe that marijuana could potentially cause the onset of psychosis and may also exacerbate symptoms of psychological conditions that cause psychosis. Research indicates that marijuana ought not to be prescribed to those who have been diagnosed bi-polar disorder with mania or those who are suffering from schizophrenia since it could induce a psychotic or manic episode. There is similar evidence for the development of borderline personality disorder due to marijuana abuse, when a genetic propensity exists for the development of these conditions.

Marijuana use may have associated risks along with medical benefits, but the same can be said for any number of pharmaceutical products being covered under health care insurance plans. The treatment of insomnia with opioid based medication has similar risks as that posed by marijuana and likely to be far more severe.

Addiction to marijuana is not as intense as addiction to opioid based medication. Overdose injuries from cannabis are uncommon to say the least. If addiction and withdrawal do occur, the effects are not as intense as those for opioid addiction. Fact of the matter is, marijuana presents a viable solution that mitigates the risks posed by conventional treating methods for a wide range of conditions without compromising treatment effectiveness.

Just as with any other pharmaceutical product there is a need to develop standards and regulations that would dictate the medical use of marijuana. Earlier, we have made reference to the institutional obstacles that slow down the process of creating policies to control the use of medical marijuana; there are standards of practice that many administrative boards have implemented yet there is no legally binding set of instructions.

It is possible to summarize the reluctance of insurance providers to extend coverage for medical marijuana; Marijuana has little to no established medical value and should be considered a recreational substance. To make a claim like that is to deny the medical value that marijuana has for the treatment of conditions that are likely to impair people for all their lives. The continued use of marijuana for recreational use is going allow this perception to persist even though there is an obvious need for greater research in the medical value of marijuana.

There is an obvious drawback to this; those who require marijuana for medical purposes and cannot afford it shall be stripped of access to a viable treatment option. The question that needs to be asked is; when there is a less painful, equally as effective treatment method why is it not a part of standard health care spending plans? The answer is rather simple; for as long as marijuana is considered a drug to be used for fun, there will be little research and policy efforts that would allow it to be established as a valid treatment method.

Canacall has always stood for the medical use of marijuana and all the controls over marijuana that come with it. We believe that it is possible to bring marijuana under the heading of health care supplement in forms such as CBD oil (isolated or full spectrum) or as a part of fully fledged treatment plans for illnesses. We believe that the recreational use of marijuana is likely to be detrimental and will have harmful implications for the exercise of health care leaving it reductive and ineffective.

It is ironic that it is easier to buy and use marijuana for recreational purposes, yet the access to medical marijuana is still as difficult as it was before. The problems associated with the regulation and controls of marijuana are symptoms of a deeper problem. Whether it is a lack of medical research, skewed awareness of the risks associated with the use or institutional reluctance to admit the value of marijuana, each of these phenomena are based on ill and preconceived notions about marijuana.

Unfortunately, these notions involve a misrepresented association of marijuana with dysfunctional behaviour. We believe that this conclusion can only be drawn as long as the chemical properties of marijuana/cannabis are not clearly presented to the wider public. The reason cannabis or marijuana induces an altered state of consciousness is the presence of tetrahydrocannabinol (THC) in the substance; THC has strong correlation with the sensation of intoxication and sedation when cannabis is used recreationally. However this is not the only type of cannabinoid, the reason why marijuana has therapeutic value is the presence of other cannabinoids that work to as anti-oxidants and stress relievers.

Cannabis contains many other chemical substances such as cannabichromene (CBC) and cannabidiol (CBD) that are responsible for the healing properties of cannabis. Most medical cannabis products use these two substances in isolation during production. This implies that while it is possible to use cannabis by-products in a manner that’s therapeutic, it is not necessary that one would get “high” when using these products. If you are not entering into an altered state of consciousness, then there is no dysfunctional behaviour associated with the use of medical cannabis.

Of course, it is not the case that THC has no therapeutic value in controlled doses. In fact, it is an overstatement to say that THC even causes dysfunction to the extent that it ought not to be considered for medical use, since it does not impair individuals to the extent that other possible treatments would.

The movement for greater accessibility to marijuana is founded on the fact that there is no harm in the use of marijuana; the substance can be used as part of medical treatments and generally has greater benefits than the harms that are posed. While there is much to be said in support of the movement, the approach towards improving accessibility to cannabis requires a more nuanced approach. The first step towards this is to establish the centrality of cannabis in maintaining healthy lifestyles and promoting the health of users.

This requires letting go of the narrative that marijuana can be used recreationally. It is not the case that there are no risks associated with the use of marijuana. We have already identified some potential contraindications for the use of marijuana; any reason for why marijuana might be harmful is because of a lack of guidance regarding the safe use of the drug.

While the risks associated with marijuana, when used recreationally, may be as manageable as with the use of alcohol this does not change the need for control. Many individuals choose to self medicate with marijuana or keep buying substandard strains that may be potentially harmful when used. This therapeutic theme, as one of the major reasons for the use of marijuana, requires much attention.

We have stated that the absence of a DIN is a major reason for why insurance providers do not extend coverage for medical marijuana. The narrative for recreational marijuana poses a problem because there is no Drug Identification Number for recreational drugs. This poses no problems insofar as the recreational use of marijuana is concerned; there is a bigger problem when certain strains are used medicinally as well as recreationally.

One possible policy conflict we ought to expect is that once certain strains of marijuana are qualified for medical use and are assigned a DIN, the regulations that dictate the procurement and use of medicinal marijuana will clash with the regulations for recreational use. There will be a need to extend much more stringent control on the extension of coverage for medical marijuana, since insurers will need to ensure that no coverage is being extended for recreational use.

Another problem this poses is creating legislation for a drug that lies somewhere in the grey area between medicinal and recreational use becomes far more complicated. Lawmakers would have to either make marijuana an over the counter medication that requires no prescription to buy, which poses the risk of marijuana abuse and leaves the insurer open to exploitation. From a legislative stand point there is also a need to change the perspective with which marijuana regulation is formed.

The one possible solution is to consider medical marijuana as a pharmaceutical product much like any other. Once the medical status of marijuana is established and agreed upon, treating it as a medication that requires prescriptions to be used is the simplest possible outcome. This mitigates the risks of marijuana abuse, curtails the access adolescents could have to the substance and it will also allow those who require it for medical purposes to get insurance coverage.

Each of these steps require changing the conversation on marijuana and changing perceptions of the substance from that of a sinister drug, which it is not, to a useful medical aid which it can very likely become.

Initiating conversations on marijuana that are centered around standard pharmaceutical testing and enlightening the wider society about the therapeutic role of marijuana would be a first step in increasing access to medical marijuana.

Even though many claim that the legalization of recreational marijuana is a step towards greater access to marijuana, the grounds for the legalization are still to curtail access of marijuana to adolescents. Lawmakers and institutions are unwilling to accept the possibility that marijuana could be a useful addition to health care given the all-round wholesome effects of controlled marijuana use.

For as long as the underlying principles that dictate all policy and research on marijuana are biased against the substance, it is very unlikely that perceptions on marijuana will ever change. This creates a cyclical chain of events where negativity associated with marijuana leads to lack of research and awareness that just feeds into the already existing negativity about the substance. This chain can only be broken by a proactive approach that undoes the negativity through institutional support.

Your Health, Your Choice

Medical insurance is one of the central components of developing universal, non-discriminatory health care systems. The refusal to explore alternative and effective treatment methods stifles the effectiveness of health care systems and also points out glaring loopholes in existing institutional frameworks.

It is the responsibility of institutions and the leading thinkers in the industry to establish the grounds for such a health care system. No one should have to forsake their physical or psychological health based on affordability issues. If something like this does happen, such as it is happening in the case of rare coverage for medical marijuana, it creates a situation of disparity where only those who are rich can acquire treatment while leaving those who cannot at the mercy of their circumstance.

It is every human’s right that they seek out and get the treatment that they feel is going to help with their illnesses. Given the increasing role of marijuana and the observed effectiveness of medical cannabis in treating or managing a wide range of conditions, it is only right that any and all possible measures be taken to ensure that patients get access to the drug.

The reasons for the reluctance of insurers to extend coverage from marijuana come from an underlying position of ignorance regarding the medical value of the substance. This value can only be established if institutional and legal frameworks facilitate the creation of a narrative that conclusively states that marijuana does in fact have medical value.

This will require letting go of the narrative that recreational use of marijuana is not harmful when factual evidence would state otherwise. The larger society needs to be made aware of the pharmaceutical application and the risks associated with the use of marijuana. Once the proper narrative regarding marijuana is established and is complemented with institutional support as well as factual evidence, it would go a long way in making marijuana accessible to all those in need.

Canacall is an active proponent of the use of medical marijuana, making efforts to educate, facilitate and provide the best quality medical cannabis related services that we can.

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