Should medical marijuana be covered?

A doctor holds a medical marijuana prescription. Stock photo by Getty Images.

Jonathan Zaid was 14 when doctors made the diagnosis: His unrelenting headaches — and debilitating pain — were caused by a condition called “new daily persistent headache.”

“I tried 48 prescription drugs and all kinds of other therapies, and none of those were indicated for my condition. The plan formulary covered every single one of those drugs without a question, but none of them were indicated or studied or researched for what I have,” said Zaid.

Eventually, he found something that worked: Medical marijuana.

Zaid is the first — and, so far, only — patient to receive insurance coverage from Sun Life Financial for medical cannabis through the University of Waterloo Student Union in Ontario.

It took a lot of education, advocacy and stigma reduction, he said — but it worked out for him in the end. 

“They finally understood that it was necessary to cover it, and saw the impact that it would have on my life and my academics. And when they looked at the cost of it, they didn’t see that it would be a huge cost… it’s not that expensive in the context of pharmaceuticals.”

As things stand, insurance coverage for medical marijuana is a rarity in Canada — Zaid’s own case with Sun Life and Medavie Blue Cross are the only two plans that are publicly known to be paying for medical cannabis, he said.

Medical marijuana is considered to be a controlled substance and, as a result, it cannot be covered under regular supplementary health benefit plans, said Wendy Hope, vice-president of external relations at the Canadian Life and Health Insurance Association in Ottawa.  

In rare circumstances, it may be covered on an exception basis at the request of a plan sponsor, as long as the plan can accommodate it. 

But that might be about to change, according to Khurram Malik, co-head of research for investment bank Jacob Securities in Toronto. 

“I think in (the near future) you’ll see some of the smaller insurance companies or the more niche-y ones covering it, and then you’ll see the larger ones,” he said. 

Obstacles to acceptance

To qualify for insurance coverage, medical marijuana would need a drug identification number (DIN), said Hope, which it currently does not have. 

“Like any new drug, medical marijuana would have to go through Health Canada’s assessment process before it could enter the marketplace as a prescription drug with a drug identification number (DIN). Only then can insurers consider providing coverage under its regular plans.”  

Stigma and misconceptions around medical marijuana are another hurdle, said Cam Battley, vice-president of communications and corporate development at Bedrocan in Toronto, a producer of medical cannabis. That’s why many in the industry use the term “medical cannabis.”

“We call it medical cannabis and that’s a very important distinction because… what we do is very, very distinct from the perceptions… and the stigmas associated with street marijuana,” he said.

There certainly are still overtones of prohibition and illegitimacy, said Bruce Linton, chairman and co-founder of Tweed Marijuana in Smith Falls, Ont. 

“(But) those go away more and more every day as we see indications of benefits across multiple user groups,” he said. 

The biggest obstacle Zaid sees, whether for insurers, HR or regulators, is education.

“People aren’t going to work and (getting) high— they want to take the medicine to improve their quality of life… and they understand they can’t work properly when they’re intoxicated.”

Employers need to understand that medical cannabis patients are not using this product recreationally, said Battley. 

“According to Health Canada statistics, the average patient is using approximately one gram of medical cannabis per day… that’s not sufficient for patients to get high, that is sufficient for patients to manage their chronic pain or manage the symptoms of an anxiety disorder,” he said. “So people are using this product responsibly.”

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