Medical Cannabis + Insurance: What We Know Now

There is A LOT of talk about recreational cannabis as Canada prepares to legalize. But let’s not forget about those who rely on medical cannabis to get through their daily lives, manage pain, anxiety, side effects, and more. One insurance provider announced they would cover medical cannabis earlier this year. So we’re breaking down what this could mean for those who use and pay for marijuana meds moving forward:

Is insurance coverage of medical cannabis new?

Not exactly. The coverage of medical cannabis has been possible for some time now. If you have a health care spending account through your insurance, you can usually use these funds towards medical cannabis. Most of these accounts use CRA guidelines to determine what’s eligible, and marijuana is on the CRA list. If you don’t have a health care spending account, medical cannabis can be claimed on your tax return, but there are stipulations about the amount that can be claimed.

Either way, those using medical cannabis would need to adhere to the Access to Cannabis for Medical Purposes Regulations. These regulations require visiting a health care professional to get medical documentation for use and registering with a licensed producer (LP) of cannabis. The medical cannabis is then sent directly through the mail.

As of March this year, Sun Life became the only insurance company to offer medical cannabis coverage in its standard plan. This doesn’t mean it’s automatically covered for those who currently have Sun Life as an insurer, or even for those who may in the future. The word option is important; plan sponsors (the employers who administer insurance for their employees) will need to opt into and pay for this coverage.

While Sun Life was the first to market, it’s likely that others will join the trend once medical cannabis has a drug identification number or DIN. Which leads us to…

What is a DIN and why should I care?

A drug identification number (DIN), is a number assigned by Health Canada to prescription drugs – and unfortunately medical cannabis does not have one yet. Not only is this a barrier for doctors, who can only prescribe drugs with a DIN, it’s also a challenge for insurance companies who use the DIN to process claims. We don’t know when cannabis will have a unique drug identification number, as the process requires strict study about the efficacy of the drug in controlled settings, and cannabis research has been heavily restricted in the past. It is also possible that cannabis will not be given a DIN due to the variability in strains and cannabis products. In the meantime, Sun Life will cover cannabis under “medical services and equipment” instead of prescription drug benefits.

What does coverage of medical cannabis look like?

Currently, Sun Life covers the use of medical cannabis for five medical conditions:

  1. Cancer
  2. Rheumatoid Arthritis
  3. Multiple Sclerosis
  5. Individuals in palliative care

However, there is some flexibility. A patient can appeal for coverage for a condition outside of this list with proper documentation. This is important, as cannabis use is highly individual and its medical benefits are not yet fully understood. Sun Life will also revisit the approved list of conditions periodically as new research is published.

The plan will cover $1,500 to $6,000 of medical cannabis per year per person. The latter amount is equivalent to approximately one gram of cannabis per day, which may not be enough to cover the costs for some patients who require more to manage symptoms. Also, different products such as tinctures or oils are often more expensive.

Will the new recreational cannabis system affect the medical cannabis system?

While many medical cannabis users welcome the normalization as a whole, there is concern around the maintenance of separate medical and recreational systems. Certain strains are developed for their particular therapeutic properties to be used medically, which is different than recreational cannabis products that are developed with their psychoactive properties in mind (meaning the type of high you get). Check out our previous post to learn more about the different types of cannabis strains. Users of medical cannabis want legitimacy (meaning separation from recreational use), and the eradication of the medical system would do the opposite. Consider this: Would you go to a liquor store to buy medication?

What will my employer think of medical cannabis?

While employers have a duty to accommodate employees, it’s unclear whether employees will face challenges for disclosing their medical cannabis use to employers, particularly in occupations that enforce a strict drug policy (think: police officers and teachers). Another major issue to address is travelling with medical cannabis into countries where it is illegal.

There are still many questions and unknowns about the fate of cannabis coverage from the broader insurance industry, and we are still in the infancy stage. Stay tuned as the situation unfolds – and in the meantime check out our video: What You Need to Know About Medical Cannabis.

*Information provided by a major insurance carrier in the industry

You may also be interested in

#YWBC Profile: Sylvia Soo
Cancer is Crap: Friday Night in Emerg
Four Days to Decide My Family’s Fate
50 Carroll Street Toronto, Ontario Canada M4M 3G3
Phone: 416 220 0700
Registered Charity #: 892176116RR0001

Join Our Movement

Follow Us

Donate Now

You can make a positive impact in the lives of people impacted by breast cancer