As conversation shifts to recreational marijuana and its likelihood of legalization in New York, some lawmakers are attempting to address longstanding concerns with the state’s medical marijuana program — namely, that it’s still too expensive for many who need it. A bill introduced last week by Assemblyman Richard Gottfried and cosponsored by 17 of his Democratic colleagues could lower out-of-pocket costs for patients by requiring public health plans in the state, including Medicaid, to cover the drug. This would greatly expand access, as most insurers currently refuse to cover the drug because of its federal status as a Schedule I drug.
According to the Controlled Substances Act of 1970, this means that marijuana has high potential for abuse and no accepted medical use. While small-scale studies and anecdotal evidence refute this (marijuana effectively treats pain, epilepsy and wasting syndrome, among other things), insurers won’t risk paying for a drug that the federal government outlaws.
“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids,” the Gottfried bill memo reads. “While it can be prohibitively expensive for many patients, especially in the absence of insurance coverage, it may often be less expensive than what their insurance coverage pays for other medications.”
The bill would deem medical marijuana a prescription drug, covered drug or health care service in order to authorize its coverage under a handful of public insurance programs, including Medicaid, Child Health Plus, Elderly Pharmaceutical Insurance Coverage (EPIC), Essential Plan programs and workers compensation.
For Medicaid and Child Health Plus, there would presumably not be federal matching funds until the federal government changes its marijuana policies, the memo states. But New York’s Medicaid and Child Health Plus programs have always covered people and services for which the state doesn’t receive a federal match, it adds.
Coverage would be optional for commercial insurance plans. However, if the plan were providing coverage under the public health plans, such as Medicaid managed care plans, managed long-term care plans, Child Health Plus plans, or the Essential Plan, medical marijuana would have to be covered.
Lawmakers say the bill is needed in order to boost access to the state’s medical marijuana program. Cost remains the top barrier for patients who are recommended to take the drug. Some patients start treatment, only to stop when they realize how much ongoing care would cost, while others turn to the black market.
Some of the organizations registered to sell medical marijuana in the state offer discounts for those in financial need, but lawmakers say the discounts have not been enough to make a sizable difference.
“Access to medical marijuana should not be limited to those who can pay out of pocket,” the bill memo says.
There are currently 77,619 patients certified to participate in New York’s medical marijuana program, according to the program’s website.
New York earned low scores for its medical marijuana program, especially on access and functionality, from Americans for Safe Access, a medical cannabis advocacy organization that grades states based on the ability of patients to access the medicine, among other things. Lawmakers were unable to say how much the proposed new requirements would end up costing the state, but theorized that there could be “substantial savings” if marijuana displaces other prescription drugs such as opioids.
The potential to curb opioid use is what compelled Republicans in the state Senate to recommend a similar proposal. In a report issued Wednesday by the 29-member Senate Task Force on Heroin and Opioid Addiction, senators proposed expanding insurance coverage for medical marijuana as a way to combat the opioid epidemic.
In particular, they pointed to the recent decision of the state Workers’ Compensation Board to cover medical marijuana for those injured at work.
“New York must address the disparity between medical marijuana coverage for those injured at work and the lack of coverage for individuals outside the workers’ compensation system,” they wrote in the report.