Medicare coverage of medicinal marijuana long way off

Many older adults are using medical marijuana to treat a variety of conditions, but experts say that conflicting laws, unclear safety standards and complicated rule-making mean it could be years before Medicare may cover the drug.

One in 5 Medicare recipients use medical marijuana, according to an April 2022 poll by the Medicare Plans Patient Resource Center, an organization that provides Medicare guidance and information. And nearly a quarter have used it in the past. Two-thirds of Medicare recipients think Medicare should cover it, the poll found.

But Medicare doesn’t cover medical marijuana because it’s not federally legal and not approved by the Food and Drug Administration. Here’s where the situation stands.

Medical pot for older adults

In one analysis of data from a large cannabis dispensary in New York, 60 percent of patients were 50 or older, according to an April 2022 paper in the journal, Cannabis and Cannabinoid Research. The patients used cannabis for severe or chronic pain, cancer, Parkinson’s disease and neuropathy, among other problems.

And marijuana isn’t cheap: Patients might pay as much as $5 per dose for edible products or $5 to $20 per gram for plant buds, according to New York Cancer & Blood Specialists. That’s about $142 to $567 per ounce.

“There are some states now where insurance will cover the cost of the doctor visit or the cost of the marijuana card, but no insurance will cover the cost of the actual products,” says Debbie Churgai, executive director of Americans for Safe Access, a nonprofit dedicated to ensuring safe and legal access to cannabis for therapeutic use and research.

Federal roadblocks

The first is that the government classifies marijuana as a Schedule I drug, a category of drugs with “no currently accepted medical use and a high potential for abuse” in the United States, according to the Drug Enforcement Administration.

The second issue is that Medicare requires that the FDA approve a covered drug as safe and effective. Although the FDA has approved one cannabis-derived drug product and three synthetic cannabis-related drug products for prescription use, the agency hasn’t approved the marketing of cannabis for medical treatment.

Legal in some states

Could private insurers — companies that offer Medicare Advantage, for instance — decide to cover it?

Not likely, says Kyle Jaeger, a cannabis policy reporter and senior editor at Marijuana Moment. Major health insurers probably will decline to cover cannabis as long as it remains a Schedule I drug under federal law.

Also, private insurers rely on the FDA to guide them on which drugs to cover. Consider that the FDA released a statement in January saying that current regulatory pathways are insufficient to allow the agency to classify CBD as a dietary supplement.

Data on medicinal use

Among other things, the marketplace needs more data on the medicinal use of cannabis. “(Insurers) need data to show that the outcomes from cannabis care are equivalent to, if not better than, existing options that they do cover,” says Dr. Benjamin Caplan, founder and chief medical officer of CED Clinic, which provides services to people seeking cannabis treatment.

Considering the breadth of legal and regulatory obstacles facing the process, plus an overhaul of the dispensary system, the road to cannabis coverage is lengthy, Jaeger says. “I’d say we are many years from having that conversation and rule making for something like Medicare.”