Legal Drugs and Your Workforce: Is Medical Marijuana Covered?

Though some  still find it controversial, medical marijuana is now legal in 33 states and the District of Columbia. Doctors may prescribe it for the treatment of (or relief of symptoms of) conditions ranging from multiple sclerosis, to glaucoma, and cancer. It can stimulate appetite and calm patients receiving palliative care. But one of the most common uses of medical marijuana in the United States is pain control. This is especially important now, as we have seen the damage that opioid addiction can do.

Medical marijuana could be the answer to our overuse of opioids. One study analyzing Medicaid prescription data from 2011-2016 found that states that have legalized medical marijuana use saw a nearly six percent drop in opioid prescriptions. It’s hard to know if legal weed is the sole reason, but it is not a big stretch to say that it helped.

man on a stretcher being picked up by two men in orange pants.
When a worker is injured on the job and is in pain, the worker’s doctor prescribes treatment covered under their employer’s workers comp policy.

So if medical marijuana could possibly be a viable alternative to opioids for relieving pain due to injury, then is it something that is covered by workers comp? This is a question that has not yet been fully decided, and there is some confusion about how it works in each state – and how others are trying to make it work.

How Does Coverage for Medical Marijuana Work?

When a worker is injured on the job and is in pain, things are usually straightforward from there. The worker’s doctor prescribes treatment, which is covered under their employer’s workers comp policy. But what happens when that treatment is largely unregulated, the way that medical marijuana is? In the case of marijuana, a physician recommends the use of it and the patient chooses the method of ingesting it. Dosage and price are also still mostly unregulated, causing further confusion to insurance companies, and further resistance to covering marijuana as they would other treatments. 

According to Brian Allen of Mitchell International Inc., a technology firm that manages pharmacy transactions (among other things related to workers comp), “I am not aware of any circumstance where an insurance carrier or employer is providing reimbursement directly to a dispensary.” So how do injured workers get coverage for their recommended treatment? A patient must head to a dispensary, seek out the products, and then file for reimbursement from the payer. Most insurance companies are still a bit cagey when it comes to how they are covering this drug, and aren’t giving out much information. Most are simply saying things such as this from one of Liberty Mutual’s medical experts: “We take each case on its own merits.” Some simply won’t cover it at all, like Nationwide.

medical marijuana
Medical marijuana could be the answer to our overuse of opioids. But not all states cover it.

How Some States Are Ruling

Much of the above confusion and complication is due to the fact that the federal government still classifies marijuana as an illegal Schedule 1 substance. This means that marijuana is treated as the same as drugs like heroin. This makes for a tricky situation when employers are being asked to pay for an injured worker’s use of the drug, and when insurance companies are evaluating workers comp claims. 

Not only are dosage and cost unregulated, making for a headache in deciding what and how to cover it, but there may be some fear that the federal government will enforce the laws against marijuana. And, since it remains illegal, carriers have grounds to deny coverage of it as a legitimate treatment.

Because of the situation at the federal level, states are handling the use of medical marijuana for workers comp in different ways. For example, in the 2014 case Vialpando v. Ben’s Automotive Services,  New Mexico’s state court of appeals upheld the validity of a workers comp claim, and directed a worker’s employer and insurance company to reimburse them for the medical marijuana they were using for pain relief. This was the first ruling of its kind, and it was followed by others: in 2017, a New Jersey administrative law judge made a similar ruling. Minnesota, Connecticut, and Maine also followed suit. 

This is all a step in a positive direction for those that advocate for the use of medical marijuana for pain relief, and for those that believe injured workers should have access to it. However, other states have been more resistant. Arizona, for example, has decided that a provider cannot be compelled to pay for medical marijuana, because the drug is still illegal under federal law work.

One thing is clear about medical marijuana, whether you are in favor of it, or against it: it is not going away anytime soon. For some, it is the future of treatment for many conditions, and a way to decrease opioid use. For others, it’s an insurance nightmare.