NM can’t jeopardize all Medicaid with marijuana coverage

In an ideal world, patients would have easy, affordable access to the medicine that helps them. Unfortunately, when the medicine is derived from marijuana — still illegal under federal law in the United States — and the cost has patients seeking taxpayer subsidies, things get complicated.

Journal reporter Dan Boyd wrote Nov. 3 about the steep costs for New Mexicans who rely on medical marijuana. A Los Lunas mother of a 3-year-old girl with a rare form of epilepsy says she is dishing out $300 for about a monthand-a-half supply of cannabidiol (CBD) oil, the only medication that effectively reduces her daughter’s seizures.

Anyone’s financial struggle to afford medication — especially for a child – is heartbreaking. There’s no question the pocketbook pain is real for families footing their own bills. And there is some medical and more anecdotal evidence that cannabis and cannabis-derived products can be uniquely helpful in treating a number of medical conditions.

But at the end of the day, New Mexico can’t risk its billions-with-a-“b” in federal Medicaid dollars by bringing an illegal Schedule 1 drug into the coverage fold, a process it could pursue by requesting a federal waiver to allow Medicaid to cover medical cannabis costs in the state. No state has done this, because there’s simply too much at risk. Even if New Mexico covered medical cannabis costs with just state dollars, is there a chance this could jeopardize all the federal dollars the state gets?

The state Human Services Department, says 827,172 New Mexicans received Medicaid in September — nearly a million residents whose health care could be endangered.

There’s also the fact that covering those marijuanabased prescriptions with state dollars would cost an estimated $27 million to $55 million a year. Medicaid is already busting the state budget, with the Human Services Department asking for almost 80 million additional dollars in the coming fiscal year, bringing state spending on Medicaid to 16% of state spending and more than $1 billion annually.

That’s not to say the more than 78,000 New Mexicans active in the state’s medical cannabis program — and the 21,000 to 41,000 who are also Medicaid recipients — don’t have real medical and financial concerns. But until we have a real national conversation around medical marijuana, and some uniformity in what’s legal and what’s not, the reward is simply not worth the risk to those hundreds of thousands of families who depend on Medicaid.

Additionally, however strong the anecdotal evidence is, there’s a reason the U.S. Food & Drug Administration exists. New Mexicans —and Americans — should demand cannabis’ various medical applications be backed up with scientific trials that show safety and efficacy. Rigorous testing is the only way to get medically sound, broadly applicable information about how a drug should be used.

Fortunately, the slow pharmaceutical R&D-to-market wheels have started to squeakily turn. The FDA has approved a handful of drugs derived from, or related to, cannabis. Last year it approved Epidiolex, an oral solution with marijuana-derived CBD, for market. The drug, developed by Cambridge-based GW Pharmaceuticals, is authorized to treat seizures from two rare and severe forms of epilepsy.

Since the drug uses marijuana instead of hemp for CBD, it would be considered a Schedule 1 substance like heroin — but the U.S. Department of Justice reclassified Epidiolex to Schedule V, the least-restrictive classification. There’s no legal reason Medicaid couldn’t start to cover Epidiolex.

With 33 states legalizing medical marijuana, researchers and companies should pay attention to the mounting public desire for widespread access to safe, affordable cannabis-derived products to treat a range of conditions. And there’s the promise of a huge payday at the end of the arduous R&D process that gets drugs to market.

It’s an imperfect system, one that’s financially burdensome for families relying on cannabis-derived medications right now. But ultimately, following the letter of state and federal law and ensuring drugs are safe and effective are the best ways to protect the health and pocketbooks of the greatest number of New Mexicans.