• Home
  • /Policy
  • /Insurance and Provincial Drug Benefit Program Coverage

Insurance and Provincial Drug Benefit Program Coverage of Medical Marihuana

CMCIA Interim Policy Until Annual General Meeting 2014
Author: MedCannAccess


Issue:

Medical marihuana should be covered by both health insurance and provincial drug benefit programs (PDBPs) for the benefit of Canada. Coverage of medical marihuana would not only provide those with low incomes the ability to access the medical product they have been authorized to use, it would reduce the costs incurred by PDBPs by allowing patients to access the most efficacious medicine, as opposed to simply that which is covered.

Background:

Through the Marihuana for Medical Purposes Regulations (MMPR) doctors can prescribe medical marihuana to their patients. Patients can access medical marihuana by purchasing it from a Licensed Producer (LP).

It is estimated that on average patients use one gram of medical marihuana per day. The expected cost of one gram of medical marihuana under the MMPR is $7.50. Therefore, the expected cost for an average prescription is $7.50 per day.

The two leading synthetic versions of medical marihuana currently covered by the Ontario Drug Benefit Program (ODB) and other provincial programs are Sativex and Nabilone. The cost of these prescription drugs is $12.25 per day for Sativex[1] and $8.32 per day for Nabilone[2]. This data indicates that the pharmaceutical alternatives to medical marihuana cost the Ontario Drug Benefit Program more than that of medical marihuana.

Additionally, research conducted in the Netherlands has shown that providing cost coverage of dried medical marihuana can reduce patient visits to the hospital. In Canada, “[f]or hospitals, an acute-care bed costs about $1,100 a day. In comparison, [it is] estimated it costs a quarter of that to care for the same [patient] in the community”[3]. This highlights the need for efficacious medications, such as dried marihuana, that can manage patient symptoms and help patients avoid hospital stays.

There is a trend emerging in Canada where physicians are prescribing Sativex, Nabilone, and opiates to their patients over medical marihuana because the products are covered by PDBPs, rather than for reasons of medical efficacy. This results in unnecessary costs on an already overstretched health care system.

This cost comparison demonstrates that governments across Canada could realize substantial savings if they were to cover medical marihuana. This would provide doctors the opportunity to prescribe the product that is most effective for their patient, instead of making decisions based upon which product is covered by PDBPs. Moreover, the savings for governments would be both immediate and increasingly significant as our population ages.

Health Canada has projected that the number of Canadians prescribed medical marihuana will grow from approximately 40 000 in 2013 to 450 000 in 2023.

Canada already has a program in place to cover medical marihuana costs for veterans of the Canadian Armed Forces and for some persons under the Workplace Safety Insurance Board (WSIB).

Recommendations:

The Canadian Medical Cannabis Industry Association:

  1. Urges provincial governments to cover medical marihuana under their respective provincial drug benefit plans.
  2. Urges private health insurance organizations to offer the option to cover medical marihuana under their respective health plans.
  3. Commits to commissioning consultants to develop a strategy to achieve recommendations (1) and (2) within the next 3 months.
  4. Encourages stakeholders to work with the CMCIA as partners in the development of related policies and procedures.

[2] Price of $2.08 per 1mg of Nabilone provided by Rexall PharmaPlus 265 Eramosa Road, Guelph, ON. Daily dosage of 4mg of Nabilone provided by http://www.cesamet.com/hcp-dosing-and-administration.asp