Financial Coverage Available for Medical Cannabis

Private Insurance Coverage Details

Health Spending Accounts

Many healthcare benefits plans cover the cost of medical cannabis through the Health Spending Account (HSA) / Healthcare Spending Account (HCSA) component of the plan. A health spending account allows plan members to be reimbursed for eligible out-of-pocket, health-related expenses that are not covered by their extended health and dental plans. The Canada Revenue Agency lists medical marijuana as an eligible medical expense which may be claimed on a tax return. Most HSAs, HCSAs base their eligible benefits list on the Canada Revenue Agency List of Eligible Medical Expenses. HSAs are generally decided upon by the employer and can cover the full expense of medical cannabis.

A number of insurance providers have made medical cannabis an option on formularies available to plan sponsors.  When available, coverage is subject to usage criteria and other plan restrictions. The following provides an overview of coverage across major insurers in Canada:

Alberta Blue Cross

Coverage is available through Health Spending Accounts only.

Co-Operators Life Insurance Co.

Coverage is approved for the following symptoms:

– chronic pain associated with recognized medical conditions

– muscle spasticity in multiple sclerosis (MS)

– chemotherapy-induced nausea and vomiting

  

Prior Authorization is required for cannabis treatment in order for expenses to be reimbursed.

Desjardins Insurance

Coverage is approved for the following symptoms:

– pain related to advanced cancer

– refractory neuralgia

– nausea and vomiting caused by chemotherapy

– spasticity caused by multiple sclerosis or a lesion of the spinal cord

 

Patient must be at least 21 years old and have obtained Prior Authourization from Desjardins Insurance for their cannabis treatment.

Green Shield Canada

Coverage is approved for the following symptoms:

– Chronic neuropathic pain

– Spasticity from multiple sclerosis

– Nausea and vomiting due to chemotherapy treatments for cancer

 

Patient must be at least 25 years old and have already tried and failed standard treatments for their condition.

Great West Life

There are no specific condition-related criteria. Each case is reviewed individually. 

Prior Authorization form must be submitted.

Markers Financial

There are no specific disease related criteria or restrictions.  Each case is reviewed individually.

Manulife

Coverage is approved for the following symptoms:

– Stiffness and involuntary muscle spasms resulting from Multiple Sclerosis

– Nausea and vomiting due to chemotherapy treatments for cancer

– chronic neuropathic pain

  

Prior authorization from Manulife is required.

Medavie Blue Cross

Coverage is approved for the following symptoms:

– chronic neuropathic pain

– refractory pain in palliative cancer

– nausea and vomiting due to chemotherapy treatments for cancer

– spasticity in multiple sclerosis or spinal cord injury

 

Prior Authorization from Medavie Blue Cross is required.

SSQ Insurance

Coverage is approved for the following symptoms:

– chronic neuropathic pain

– cancer related pain

– spasticity secondary to multiple sclerosis or spinal cord injury

– nausea and vomiting due to chemotherapy treatments for cancer

 

Prior Authorization from SSQ Insurance is required; and treatment using traditional prescription drugs deemed ineffective.

SunLife Financial

Coverage is approved for the following symptoms:

– severe pain from cancer (including palliative care)

– nausea and vomiting resulting from cancer treatments

– spasticity or neuropathic pain from multiple sclerosis

– rheumatoid arthritis (when all other standard treatments have failed)

– anorexia or neuropathic pain from HIV/AIDS

 

Prior Authorization from SunLife Financial is required.

Ontario Public Service Employee Union (OPSEU)

Members of OPSEU who work in the health care sector, community colleges, the Ontario government, the LCBO,  and a wide range of community agencies within the broader public service all have medical cannabis reimbursement up to $3000.00 per year with no limitations.

Shoppers Drug Mart & Loblaws

Limited coverage is available only for terminally ill cancer patients undergoing chemotherapy treatments and patients with multiple sclerosis.

Motor Vehicle Accidents

Coverage for medical cannabis is theoretically possible and has few formal guidelines but is ultimately regulated by the Financial Regulatory Authorities in every province. In Ontario that authority is FSCO (The Financial Services Commission of Ontario). The Statutory Accident Benefits Schedule in Ontario regulates the amount of money that can be spent. Pursuant to section 15(1) of the SABS, the medical benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for medication and other goods of a medical or rehabilitative nature that the insurer agrees are essential for the treatment of the insured patient, and for which a benefit is not otherwise provided.

WSIB Coverage for Medical Cannabis (in Ontario)

Receiving Entitlements from WSIB

Provided certain criteria are met, the Workplace Safety and Insurance Board (WSIB) may grant entitlement for medical cannabis. In such cases, the WSIB will generally cover the reasonable costs of medical cannabis if it is obtained from a hospital or a licensed producer with whom the worker is registered as a client. The WSIB will also cover the reasonable cost of a vaporizer if the worker is medically authorized to vaporize cannabis. When entitlement to medical cannabis is allowed, the WSIB will regularly monitor its use and effectiveness and suspend or discontinue entitlement when it is no longer necessary, appropriate, or sufficient.

Ineligible Individuals for WSIB Entitlement:

– Those under the age of 25;

– Those with a personal or family history of psychosis;

– Those with current or past cannabis use disorder or substance use disorder;

– Those whom are pregnant, planning to become pregnant or breastfeeding;

– Those with cardiovascular disease, or severe liver or kidney disease

Designated Conditions for WSIB Entitlement:

– Neuropathic pain arising as a direct consequence of a demonstrative lesion or disease affecting the nervous system;

– Spasticity from a spinal cord injury;

– Nausea and vomiting associated with cancer chemotherapy loss of appetite associated with HIV or AIDS pain and other symptoms experienced in a palliative setting

WSIB Entitlement Criteria

Entitlement may be granted for medical cannabis for a compensable injury only if all the following criteria are satisfied:

Designated Condition

The patient must have a designated condition as outlined previously and the WSIB will consider entitlement to medical cannabis only if the patient’s designated condition is clinically associated with either a work-related injury/illness or its treatment.

Primary Treating HCP

The health professional managing the ongoing care of the patient’s designated condition must authorize medical cannabis to treat the designated condition. The same health professional is responsible for reassessing the patient’s response to medical cannabis. If another health professional authorizes and monitors the patient’s medical cannabis use, the patient’s primary treating health professional must support the use of medical cannabis for the designated condition.

Exhaustion of conventional treatments

Except in palliative care cases, the patient must exhaust conventional treatments for the designated condition before the WSIB will consider entitlement to medical cannabis. A patient is considered to have exhausted conventional treatments when they have undergone adequate trials of appropriate conventional treatments for their designated condition and such treatments are ineffective or not tolerated. The patient’s use of and response to the conventional treatments must be clearly documented in their medical records.

Clinical Assessment

An appropriate clinical assessment of the patient must be conducted before the WSIB will consider any entitlement to medical cannabis. The results of the clinical assessment must be clearly documented in the patient’s medical records to establish the necessity, appropriateness, and sufficiency of the medical cannabis treatment.

Risk Benefit Analysis

The benefits of the patient’s medical cannabis use must outweigh its risks. Increased health risks of using medical cannabis include situations where:

– medical cannabis is contraindicated;

– precautions are present;

– there is a potential for adverse drug reactions; or the treatment may impede recovery.

Route & Administration

The patient’s authorized dose and route of administration must be appropriate. A dose of medical cannabis will generally be appropriate if it is the lowest safe and effective dose in terms of daily quantity and THC percentage. Also, the dose and route of administration:

– Must not involve smoking;

– Must not exceed 3 grams of dried medical cannabis per day;

– Must be CBD-rich but contain minimal THC;

– Must have a THC concentration of 9% or less;

– and Should not exceed more than 30 mg of THC per day and in no case shall exceed 75 mg of THC per day.

Valid Medical Document

The patient must have a valid medical document or written order for medical cannabis that complies with the Policy’s criteria and specifies the maximum THC percentage of medical cannabis authorized for the worker and the route of administration.

Regular Review of Entitlement

Ongoing clinical assessment of the patient is a necessary component of approval for ongoing entitlement. Regular entitlement review will be conducted, starting with an initial review not more than three months after the initial allowance of the benefits and ongoing review thereafter no more than six months from the previous review.

Disentitlement

Misuse of medical cannabis or diversion of the product (i.e. selling or providing it to others) will result in discontinuation of entitlement.

Payment

WSIB restricts payment for the reasonable costs of medical cannabis to circumstances where the product is obtained directly from a licensed producer, such as NorthCann Medz Inc. This means that patients will not be reimbursed for the purchase of cannabis products from a licensed retailer or for the costs associated with their own production.  Moreover, approval for the use of medical cannabis or vaporizers must first be obtained by the WSIB before any purchases are made by the worker.