Sun Life first in­surer to add med­i­cal mar­i­juana to group health plans

The Globe and Mail (Prairie Edition) - - FRONT PAGE - CLARE O’HARA

Com­pany is gear­ing up to in­clude medic­i­nal cannabis un­der ex­tended health-care ben­e­fit plans, help­ing off­set costs for users

Sun Life As­sur­ance Co. of Canada will be­come the first ma­jor in­sur­ance com­pany to add med­i­cal mar­i­juana to its group ben­e­fits plans for Cana­dian com­pa­nies, a piv­otal move in the in­sur­ance in­dus­try that will help ease the fi­nan­cial bur­den for med­i­cal­mar­i­juana users, and a sign of the grow­ing ac­cep­tance of cannabis in the Cana­dian work­place.

As of March 1, Sun Life will in­clude med­i­cal cannabis as op­tional cover­age un­der an ex­tended health-care ben­e­fit plan. Sun Life, which ad­min­is­ters group ben­e­fits plans for more than 22,000 Cana­dian com­pa­nies, over­sees health and den­tal cover­age for more than five mil­lion Cana­di­ans – in­clud­ing de­pen­dents.

“We as a so­ci­ety are start­ing to see an in­ter­est­ing evo­lu­tion over time,” said Joan Weir, di­rec­tor, health and dis­abil­ity pol­icy at the Cana­dian Life and Health In­sur­ance As­so­ci­a­tion. “The num­ber of med­i­cal pre­scrip­tions that are be­ing is­sued is grow­ing at a sub­stan­tial rate for med­i­cal cannabis and in turn that means a lot of plan mem­bers are now using it … so in­sur­ers are also watch­ing this more closely.”

Sev­eral years ago, life-in­sur­ance com­pa­nies could deny cover­age for clients who were oc­ca­sional users of mar­i­juana. In 2016, Sun Life was one of the first in­sur­ers to as­sess peo­ple who use mar­i­juana when they ap­ply for in­sur­ance as non-smok­ers. Now, life in­sur­ers are look­ing to add med­i­cal mar­i­juana to their suite of cov­ered ben­e­fits, eas­ing the costs for users.

“Med­i­cal ev­i­dence sup­ports the use of cannabis for some se­ri­ous and se­vere med­i­cal con­di­tions,” Dave Jones, se­nior vicepres­i­dent of group ben­e­fits at Sun Life, said in an interview with The Globe and Mail. “As this has be­come some­thing our clients – be­ing the in­di­vid­ual com­pa­nies known as plan spon­sors – have been ask­ing us about more and more, we have moved from the stage of eval­u­ate and re­view, to now of­fer­ing it as a ben­e­fit for medic­i­nal pur­poses.”

In­di­vid­ual com­pa­nies will now be able to re­quest the added cover­age for their em­ploy­ees as well as choose a yearly ben­e­fit amount rang­ing from $1,500 to $6,000 a per­son.

The new med­i­cal-cannabis cover­age will in­clude a pri­o­rap­proval process. Plan mem­bers or el­i­gi­ble de­pen­dents will only be cov­ered if they meet the clin­i­cal cri­te­ria, as de­fined by Sun Life, and have their cannabis dis­pensed ac­cord­ing to gov­ern­ment reg­u­la­tions.

The de­bate as to whether the use of med­i­cal cannabis should be cov­ered by an em­ployee in­sur­ance plan has been a con­tin­u­ing one. Many em­ployee ben­e­fit plans do not cover pre­scrip­tions for med­i­cal cannabis since it does not have a drug iden­ti­fi­ca­tion num­ber (DIN) – some­thing that in­sur­ance com­pa­nies re­quire in or­der for a drug to be cov­ered and that are is­sued by Health Canada.

Sev­eral in­di­vid­ual cases have emerged in front of the courts in or­der to de­ter­mine an out­come.

In a land­mark rul­ing last spring, Gor­don (Wayne) Skin­ner went in front of a hu­man-rights board after he said he faced dis­crim­i­na­tion from his em­ployer when he was de­nied cover­age three times through his work­spon­sored plan. Mr. Skin­ner had suf­fered from chronic pain after an on-the-job mo­tor-ve­hi­cle ac­ci­dent.

The board ruled in Mr. Skin­ner’s favour, stat­ing his em­ployer must cover his med­i­cal-mar­i­juana ex­penses.

A user of med­i­cal mar­i­juana could pay sev­eral hun­dred dol­lars a month de­pend­ing on the size of the pre­scrip­tion. For some pa­tients, a por­tion of cost in­volved with using med­i­cal cannabis was be­ing off­set through health-care spend­ing ac­counts. But not ev­ery com­pany of­fers these ac­counts, leaving many with­out any sup­ple­men­tal cover­age for cannabis pre­scrip­tions, said Chris Gory, an in­sur­ance ad­viser with In­sur­ance Port­fo­lio Fi­nan­cial Ser­vices who spe­cial­izes in group ben­e­fits plans.

“The [added cover­age] is a big game changer for many of my clients as only one in ev­ery eight of­fer health care spend­ing ac­counts within their plans,” Mr. Gory said. “Now, Sun Life is open­ing the door for many Cana­di­ans who re­ally need ac­cess to this type of cover­age. Not only is this go­ing to help drive down pain for a lot of pa­tients, but it is also go­ing to help drive down drug costs for com­pa­nies.”

For those com­pa­nies who choose to add cover­age, there is a limit to what med­i­cal con­di­tions will be ap­proved. The cover­age will be avail­able for em­ploy­ees who are using cannabis to treat can­cer with se­vere or re­frac­tory pain; or with nau­sea or vom­it­ing as­so­ci­ated with can­cer treat­ments, mul­ti­ple scle­ro­sis with neu­ro­pathic pain; or with spas­tic­ity, rheuma­toid arthri­tis with pain that failed to re­spond to stan­dard ther­apy, HIV/AIDS and for pa­tients re­quir­ing pal­lia­tive care.

Sun Life said it will con­duct pe­ri­odic re­views of evolv­ing clin­i­cal ev­i­dence, sup­port­ing the use of med­i­cal cannabis for con­di­tions not listed. As well, plan spon­sors can sub­mit prior-ap­proval re­quests for other con­di­tions that Sun Life will ex­am­ine on an in­di­vid­ual ba­sis.

The cost of adding the cover­age takes into ac­count a num­ber of fac­tors, but ini­tially Sun Life does not ex­pect it to rise, Mr. Jones said. In the be­gin­ning not ev­ery com­pany will opt to in­clude the ad­di­tional plan; as well costs will be kept min­i­mal, for now, as a re­sult of Sun Life con­fin­ing cover­age to five spe­cific con­di­tions and symp­toms.

For other providers, cover­age ap­pears to be done on a case-by­case ba­sis. Man­ulife Fi­nan­cial Corp. of­fers sim­i­lar cover­age on a se­lec­tive ba­sis to­day, but has not of­fered it as an au­to­matic se­lec­tion for plan spon­sors.

“Man­ulife is sup­port­ive of clients that want to con­sider in­tro­duc­ing med­i­cal cannabis as an op­tion,” a Man­ulife spokesper­son said in an e-mail. “We also rec­om­mend that clients put lim­its and some man­age­ment con­trols in place as this is an emerg­ing mar­ket that is quickly evolv­ing.”


A worker trims a med­i­cal-mar­i­juana plant at Canopy Growth Corp.’s fa­cil­ity in Smiths Falls, Ont., on Mon­day. Sun Life As­sur­ance Co.’s move to add med­i­cal mar­i­juana as op­tional cover­age un­der its ben­e­fit plans is a sign of the grow­ing ac­cep­tance of cannabis in the Cana­dian work­place.

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