Does Insurance Pay for Medical Marijuana?

Does Insurance Pay for Medical Marijuana?

Cannabis Prescriptions in Utah & Health Insurance Policies

Tens of thousands of patients have medical cannabis prescriptions in Utah, also known as medical marijuana. The plant has been used to treat a variety of serious health conditions in patients whose symptoms are not responsive to traditional medications. Of course, many questions come up when considering treatment options or using medical marijuana; most often, “does insurance pay for medical marijuana?” Unfortunately, the answer is no. 

Health insurance will not cover medical marijuana products, even with a legal, medical cannabis prescription in Utah written by a qualified medical practitioner for the treatment of a patient’s health conditions. Cannabis products are currently classified federally as a Schedule 1 controlled substance. This means no accepted medical uses for marijuana are recognized and that the plant has a high potential for abuse. While these statements have not been categorically proved or disproved, the technicality makes it illegal to buy, possess, grow or consume marijuana, despite any state law allowing for legal use, whether medically or recreationally. 

Still, faith groups, policymakers, and patients’ rights advocates worked tirelessly in partnership with state lawmakers to create the Utah Medical Cannabis Program. The program launched in March 2020 to provide treatment options for Utah patients with qualifying conditions

But federal law isn’t the only thing keeping insurers from offering cannabis prescriptions in Utah. Health insurers will routinely deny coverage of any drug that does not have FDA approval for use. In turn, the FDA will not approve cannabis prescriptions in Utah or anywhere else for that matter, until research proves it’s safe and effective. With a few notable exceptions, cannabis research has largely been prohibited due to the federal government classification and illegality. Federal legalization of marijuana is unlikely to sway health insurers, however, a few companies have indicated they are open to considering adding coverage in the future.

Does having a medical card affect your health insurance? 

Health insurance rates are highly regulated, and all premiums are set using five factors. Having a medical card should not affect your health insurance premiums, but as we’ve already established, all coverage for medical marijuana-related treatment of a health condition will be routinely denied. According to Healthcare.gov:

Under the health care law, insurance companies can account for only five things when setting premiums.

  • Age: Premiums can be up to 3 times higher for older people than for younger ones.
  • Location: Where you live has a big effect on your premiums. Differences in competition, state and local rules, and cost of living account for this.
  • Tobacco use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.
  • Individual vs. family enrollment: Insurers can charge more for a plan that also covers a spouse and/or dependents.
  • Plan category: There are five plan categories – Bronze, Silver, Gold, Platinum, and Catastrophic. The categories are based on how you and the plan share costs. Bronze plans usually have lower monthly premiums and higher out-of-pocket costs when you get care. Platinum plans usually have the highest premiums and lowest out-of-pocket costs.

We hope this helps answer your questions about cannabis prescriptions in Utah for medical conditions and health insurance. If you have more questions or concerns, contact your medical provider. Looking to find a trusted pharmacy to help guide your medical marijuana process? Stop by one of our locations and our pharmacists can provide the knowledge necessary for navigating your cannabis prescriptions in Utah.

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