Physicians interested in recommending medical cannabis are already completing the two hours of continuing medical education credit necessary before applying for a Certificate to Recommend from the State of Ohio. The Ohio Medical Board projects the application for a Certificate to Recommend will be available in the Spring of 2018. Physicians have also been brushing up on how to properly recommend medical cannabis by utilizing my Ohio Physician’s Guide To Cannabis Compliance. Clearly, physicians are preparing themselves for this new form of treatment, but for Ohio hospitals, the question remains, are you ready?
Are you prepared to allow your physicians to recommend medical cannabis to a patient? What if an inpatient with a recommendation has medical cannabis in her pocket – will you allow her to keep it? Should she self-administer her recommendation or should a physician or mid-level provider do that? Would that violate the Controlled Substances Act? How will the medical cannabis interact with other drugs the patient has already received? Could the hospital lose its Medicare enrollment or other federal licenses? Should the hospital take the medical cannabis and store it until the patient needs another dosage? It’s dizzying, I know.
These are just some of the questions that need to be addressed by an Ohio hospital’s leadership before the medical cannabis program begins in September of this year. Hospitals need to understand the risks associated with medical cannabis and have clear policies addressing how the hospital will handle the new treatment. If a hospital will allow medical cannabis, it must ensure that its policies detail procedures that strictly comply with Ohio’s medical cannabis law to firmly protect against any potential federal prosecution under the Rohrabacher-Blumenauer Amend-ment (the “Amendment”).
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I’m getting asked about health insurance coverage of medical cannabis: can employers buy plans that cover it? Even the California Department of Insurance is trying to track this and has reached out to me to see if there is coverage available in traditional health insurance markets.
The answer is no, coverage of medical cannabis is not found in traditional fully-insured plans. (Self-Funded plans and other methods are not addressed in this article.) Notably, a New Jersey judge recently set a precedent for coverage under workers’ compensation. The judgment, how-ever, is limited in scope as it is a workers’ compensation judgement and doesn’t have a direct precedent for medical insurance coverage. Medical cannabis is also not covered through the Affordable Care Act (Obamacare), Medicaid or Medicare at this time.
Why Not? The reasons should sound very familiar:
• Illegal at the federal level
• Not FDA approved
• Schedule 1 Controlled Substance – considered with no medicinal purpose
• Limited research – only 500 clinical trials in motion, with much more needed beyond that
• Growing, manufacturing, testing, and medical treatment protocols aren’t yet uniform, approved, or rolled out
• FDA safety testing, packaging and labeling, holding practices, compliance and inspections, approval of health claims, adverse event reporting protocols, and standardized systems aren’t yet finalized and rolled out for cannabis medications
• Training of traditional medical providers in cannabis protocols hasn’t happened
Remarkably, once the above has happened and is ready, I predict health insurance still won’t cover it. And not because the industry doesn’t want to.
This begs the question of why. Why not fund a less expensive and less toxic option for treatment of epilepsy? Or chronic pain? Or nausea? Or improving the impact of radiation?
It makes no sense unless we factor in “Adverse Selection,” an insurance underwriting term.
Underwriting