Health Insurance Coverage Now Includes Marijuana

byAlanaArmstrong4 minutes

A major Canadian health insurance firm will be covering up to $6,000 of medicinal cannabis for some clients. Toronto-based insurer Sun Life Assurance Co. has added medical marijuana as an option for its group benefits plans.

“Sun Life’s approach reflects current evidence-based clinical knowledge regarding the medical use of cannabis,” the insurer said in a press release.

Sun Life provides health benefits coverage to more than 22,000 companies in Canada. Its coverage reaches three million Canadians and their families—that’s one in six Canadians.

Sun Life's Cannabis Plan Basics

Employers who offer this brand’s insurance have the option to add medical cannabis coverage as of March 1. The yearly plans range from $1,500 to $6,000 per person per year. This comes out to about one gram of marijuana per day—but it's not easy to qualify for the coverage.

Although Health Canada recognizes numerous conditions under the Access to Cannabis for Medical Purposes Regulations (ACMPR) that can be treated with medical cannabis, Sun Life recognizes only a few as qualifying for their marijuana coverage:

  • Cancer
  • Multiple sclerosis (MS)
  • Rheumatoid arthritis
  • Patients in palliative care

The company itself will approve the eligibility of those seeking coverage on a case-by-case basis.

These conditions tend to require higher recommended daily doses of cannabis, costing the average consumer buying from a licensed producer (LP) between $10,000 and $80,000 each year. They also represent the types of cases that rack up more time in the hospital than most other chronically ill patients. Whether greater access to cannabis lessens the time these patients spend in hospital is something we have yet to understand.

Reactions From Canadian Cannabis Advocacy Groups

This move by a major insurer has been a long time coming for patient advocacy groups like Canadians for Fair Access to Medical Marijuana (CFAMM) and NORML Canada. Both groups have witnessed and been a part of years of litigation in the fight to gain a healthier, destigmatized vision of cannabis in health and wellness.

CFAMM helps patients with life-altering ailments like cancer, rheumatoid arthritis pain and palliative care—conditions so debilitating they make it hard for patients to maintain their employment. They hope to see more plan sponsors include this specialized coverage in their benefits plans.

Craig Jones, the executive director of NORML Canada, is also counting on the cost of cannabis going down after Canada implements marijuana legalization and regulations this year.

3 Things That Would Push Other Insurers to Include Marijuana

Sun Life taking this step is a big deal. Not only does it legitimize using marijuana as medicine, but it also gets the company a lot of goodwill. What else would be needed for other insurers to make the same move?

  1. Coverage of the full cost of medicinal marijuana—and not just for the equivalent of one gram per day—by provincial disability support programs.
  2. Quality research into cannabis and its uses. There’s a lot of pushback to do with the lack of definitive evidence for cannabis as an effective medicine. Studies on cannabinoids are either too old, too inconclusive, too small or too new—and research is vastly underfunded.
  3. A properly defined marijuana dose. People tend to like medicines that come with dosage instructions. It seems that many folks only consider something a legitimate medicine when an authority prescribes a specific amount.


Will Other Canadian Insurance Companies Cover Cannabis?

Insurers are under pressure to maintain conservative values and historically don't rush into offering new coverage options, especially when they're as controversial as cannabis. And especially as marijuana isn’t approved by Health Canada under the Food and Drugs Act and therefore has no Drug Identification Number (DIN). Sun Life’s coverage has to categorize medical cannabis under “medical services and equipment” rather than under a drug benefit to get around the fact that there’s no cannabis DIN.

And with The College of Family Physicians of Canada distributing their "Simplified Guideline for Prescribing Medical Cannabinoids in Primary Care," which recommends almost never prescribing medicinal cannabinoids over conventional medicine, it's safe to say that cannabis is walking against some strong headwinds.

Sun Life is the first major Canadian insurance company to take this step and hopefully won't be the last. Now that other companies see it can be done, it's time for plan sponsors to put the pressure on their provider that Sun Life's clients put on them.

Photo credit: Hush Naidoo