20 years of legalization: 5 things plan sponsors may not know about medical cannabis in Canada

20 years of legalization: 5 things plan sponsors may not know about medical cannabis in Canada

 

July 30, 2021 marks the 20 year anniversary of the legalization of medical cannabis in Canada,[1] with Canadian Medical Marijuana Access Regulations granting access to cannabis for individuals with HIV/AIDS and other illnesses.[2] Legalizing medical cannabis has meant more relaxed regulations, an increased number of producers, greater access for patients, reduced stigma about cannabis use, and significant advances in the industry.

Current landscape of medical cannabis

Even after 20 years, many doctors are still hesitant to prescribe medical cannabis. In a recent study conducted by McMaster University, Ontario physicians surveyed expressed their concerns over possible negative effects and a lack of guidance regarding its effectiveness as a pain reliever.[3] In contrast, more evidence continues to emerge that shows cannabis provides users with relief and enhanced well-being, citing the connection between physical pain and the impact on mental health and disability management.[4] With greater demand for empirical data and research on medical cannabis, Health Canada is being called on to remove barriers to testing these products more extensively.

The number of Canadians using medical cannabis has soared from just under 24,000 in June 2015, to 377,000 as of September 2020.[5] According to a study by the Centre for Addiction and Mental Health, 52% of cannabis users reported an increase in their consumption during the first wave of the pandemic.[6] With more individuals turning to cannabis use to deal with chronic pain as well as pandemic-related stress, isolation, and boredom, it’s important for physicians and patients to discuss treatment options for health conditions and the appropriate application of medical cannabis.

Most drug plans cover medical cannabis prescribed to treat:

  • Severe pain caused by cancer
  • Nausea and vomiting caused by chemotherapy
  • Spasticity and/or neuropathic pain caused by multiple sclerosis
  • Pain related to rheumatoid arthritis
  • Anorexia and neuropathic pain caused by HIV/AIDS  
    pain
  • Pain and symptoms for those in palliative care

Because it’s a CRA allowable medical expense for income tax purposes, medical cannabis is an eligible expense under Health Care Spending Accounts (HCSAs). . Reimbursement under   HCSAs doesn’t include the same strong claims controls as a traditional health plan, or the additional support plan members can get through active case management.

Confirmed or busted? Five myths about cannabis:

  1. All cannabis produces a high and your employees will show up to work high: BUSTED

    Some strains of cannabis can get the user high and compromise their ability to do their job but there are more strains that don’t get the user high.
  • The active cannabinoid THC, the found in some strains of cannabis will give the user an altered state of being
  • The active cannabinoid CBD, is one of many that doesn’t alter the user’s brain state

    Even if drugs or alcohol have been consumed, employees can be unaffected and capable of doing their jobs – and, even if they have a medical cannabis prescription, employees are bound by the drug and alcohol policies of the companies they work at.

    2. Cannabis helps with a wide variety of afflictions and conditions: CONFIRMED

    Cannabis is helpful in alleviating the symptoms of many chronic conditions and improves the quality of life of many users. Symptoms from a host of conditions can be controlled from cannabis treatment, including chronic pain, insomnia, and glaucoma, however most drug plans cover cannabis prescriptions for a limited list of conditions.   

    As the landscape of medical cannabis evolves, People Corporation continues to keep our clients informed of the changing legislation, risk management, and carrier stance on coverage.

    For more information on what Health Canada has to say about cannabis, visit their website.

    3. Medical cannabis is superior to recreational cannabis: CONFIRMED

    Despite recreational cannabis being legal in Canada, having a medical prescription for cannabis has advantages. Medical cannabis is rigorously tested[7], and patients often have a wider variety of consumption routes available. Unlike medical cannabis, recreational cannabis isn’t an eligible medical expense under health plans as currently defined under the Medical Expense Tax Credit, regardless of whether the cannabis is being used to treat a medical condition or not.[8]

    4. There’s no stigma anymore: BUSTED

    Even though medical cannabis was legalized two decades ago, there’s still stigma surrounding the use of cannabis. It’s important that plan members feel comfortable submitting claims for any drug they’re prescribed, and there’s work to be done on reducing the stigma of using medical cannabis to treat chronic conditions.

    5. Plan members want medical cannabis covered by their drug plan: CONFIRMED

    According to employee feedback, 64% of plan members[9] believe that medical cannabis should be covered.
https://www.sanofi.ca/-/media/Project/One-Sanofi-Web/Websites/North-America/Sanofi-CA/Home/en/About-us/The-Sanofi-Canada-Healthcare-Survey/The-Sanofi-Canada-Healthcare-Survey-2018---Infographic.pdf?la=en&hash=A98D33419E02156540D743E9F5982C617BB9558E
https://www.sanofi.ca/-/media/Project/One-Sanofi-Web/Websites/North-America/Sanofi-CA/Home/en/About-us/The-Sanofi-Canada-Healthcare-Survey/The-Sanofi-Canada-Healthcare-Survey-2018—Infographic.pdf?la=en&hash=A98D33419E02156540D743E9F5982C617BB9558E

What can plan sponsors do?

With changing legislation and increased demand, plan sponsors are increasingly considering the addition of medical cannabis coverage to their group benefit plans. It’s important for plan sponsors to evaluate whether their group benefit plans adhere to their plan guidelines of including or excluding coverage for medical cannabis, and whether an exclusion will stand in their jurisdiction.[10] 

With the legalization of recreational cannabis use in October of 2018, plan sponsors should also work with their advisor and insurance carrier to discuss which conditions would be covered should they choose to add medical cannabis to the list of covered prescription medication.

Contracts and plan member booklets should provide clear and explicit provisions to avoid ambiguity and confusion around the coverage of medical cannabis claim. With over 321,000 Canadians with active medical cannabis authorizations as of the end of 2020,[11] proper approval procedures like prior authorization, should be in place to ensure a seamless employee experience.

If you’re considering coverage for medical cannabis to your HCSA in your group benefits plan, or if you’re unsure if already included, connect with your consultant or contact us so we can help evaluate your current plan.

Written by Atul Goela, Vice President, Growth Initiatives and Taylor Valee, Consultant, Enterprise Group Solutions at People Corporation


[1] https://laws-lois.justice.gc.ca/eng/regulations/sor-2001-227/20140307/P1TT3xt3.html
[2] https://london.ctvnews.ca/medicalmarijuana/a-timeline-of-some-significant-events-in-the-history-of-medical-marijuana-in-canada-1.3858860
[3] https://healthsci.mcmaster.ca/home/2021/04/13/province-s-doctors-lack-direction-on-medical-cannabis
[4] https://www.benefitscanada.com/news/bencan/how-three-benefits-plan-members-are-receiving-medical-cannabis-coverage/
[5] https://healthsci.mcmaster.ca/home/2021/04/13/province-s-doctors-lack-direction-on-medical-cannabis
[6] https://globalnews.ca/news/7693366/canadian-cannabis-users-increased-habit-coronavirus-pandemic/
[7] https://cannalogue.ca/column/column/education/medical-cannabis-vs-recreational-cannabis/
[8] Government of Canada, Medical Expenses, 2017 (https://www.canada.ca/en/revenue-agency/services/forms-publications/publications/rc4065/medicalexpenses-2016.html)
[9] https://www.sanofi.ca/-/media/Project/One-Sanofi-Web/Websites/North-America/Sanofi-CA/Home/en/About-us/The-Sanofi-Canada-Healthcare-Survey/The-Sanofi-Canada-Healthcare-Survey-2018—Infographic.pdf?la=en&hash=A98D33419E02156540D743E9F5982C617BB9558E
[10] https://blog.ifebp.org/index.php/marijuana-coverage-calls-for-clear-and-explicit-plan-language
[11] https://www.cbc.ca/radio/thecurrent/the-current-for-may-11-2021-1.6021707/after-20-years-of-medical-cannabis-gaps-in-product-testing-leave-some-canadians-feeling-like-guinea-pigs-1.6026923