Medical Marijuana Is Here To Stay: What Review Organizations Need to Know

Medical Cannabis

With voters in five states passing ballot measures to approve the use of medical or recreational marijuana, the 2020 election cycle shows that the trend of relaxing laws surrounding cannabis continues to gain traction.

In the aftermath of the most recent election cycle, state legislatures in Arizona, Mississippi, Montana, New Jersey and South Dakota are now grappling with questions on how to proceed with these newly enacted marijuana laws. Those states join 35 other states that, to date, have approved legal recreational or medical marijuana. Only four states (Idaho, Kansas, Nebraska, and South Dakota) have an outright ban.

Big questions remain

Despite the expansion of approved use, most jurisdictions have not set a precedent for how insurers should cover the use of marijuana for medical purposes, according to analysis from mPower by Mitchell.

Employers are often struggling with how to handle medical marijuana in states where it’s been approved, notes Doug Lurie, M.D., Medical Director with Nexus, a URAC-accredited workers’ compensation utilization management (WCUM) firm, and also Medical Director of ProPeer Resources a URAC-accredited independent review organization (IRO).

“There are so many issues that haven’t been delineated yet,” Lurie says.

For instance, how should an employer handle drug screening? And, in cases where an employee gains a medical marijuana prescription, is there enough evidence to show that the treatment is having the desired effect?

In many states, workers’ compensation is the only form of coverage where medical marijuana is covered, according to industry insiders. Federally, marijuana is considered a Schedule I drug. But in some states, including New Mexico and New Jersey, employees can access a medical marijuana prescription via workers’ compensation coverage.

In one of the few rulings on medical cannabis coverage to date, the New Mexico Court of Appeals ruled in a 2014 decision that an employer and its insurer had to cover medical marijuana for an employee following an on-the-job injury.

A recent publication on the topic from NAIC spell out the current landscape facing consumers and involved stakeholders: “Individuals using cannabis also face insurance challenges ranging from legality issues to coverage deficiencies,” the NAIC report states. “Users may be faulted in workers’ compensation claims or subject to employment-disqualifying drug screening. In addition, insurers offering medical treatment options may have policies preventing the use of cannabis in treating a patient’s condition.”

Coming to the fore

It remains to be seen how different states will interpret cannabis coverage laws, but as the popularity of the treatment explodes nationally, review organizations can expect to see more cases crop up. In 2018, sales of legal marijuana in the U.S. reached $8 billion, and that number could rise to $40 billion as soon as 2025, according to a report from advisory firm New Dawn Risk.

Ultimately, the lack of consistency among states may lead to challenges for employers, as well as review entities.

“If I put my utilization review hat on, we would want to see improvement in pain, work status and functioning,” Lurie says. Questions remain about medical marijuana’s efficacy in returning employees to full functionality, Lurie adds.

Generally speaking, much of the medical community supports the use of medical marijuana, says Eloise Theisen, RN, MSN, ACPCNP-BC, president of the American Cannabis Nurses Association. However, medical providers often “feel ill-equipped to discuss it,” Theisen adds.

Yet given the rising rates of legalization and consumption around the nation, stakeholders – employers, medical providers and payer groups – may be forced to confront the issue sooner than later.

“Organizations are really going to have to start addressing this,” Theisen says.

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