Does Medicare Cover Medical Marijuana Prescriptions?

As new and alternative treatments are accepted by the medical community, insurance programs consider how coverage may apply for their enrollees.

If you have Medicare and have been considering alternative treatments to help manage a chronic condition, such as the use of medical marijuana, you may be wondering if your benefits will cover the costs.

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Marijuana Controversy

In the United States on the federal level, it is illegal to use marijuana for either recreational or medicinal purposes, though some states have legalized its use. Personal and political arguments around legalizing marijuana have been going on for decades.

The controversy continues today as residents debate the pros and cons of welcoming dispensaries in communities where it is now legal. Some people are hoping for access to medical marijuana as part of their pain management plan of action.

What is Medical Marijuana?

Medical cannabis, commonly referred to as medical marijuana, is derived from the Cannabis sativa plant, which comprises 120 compounds, called cannabinoids. Some people use products containing the derivatives of the plant to lessen the symptoms of various medical conditions.

Medical Marijuana VS CBD Products

Two species of Cannabis sativa are hemp and marijuana. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the most recognized and researched cannabinoids. THC is a psychoactive compound that produces a “high,” and CBD does not have this effect. Both THC and CBD can potentially offer a range of health benefits, in some cases more effective in combination.

Potential Benefits of Marijuana

A medical journal, Cell Cycle, published “Cannabinoids as anticancer therapeutic agents” in the National Library of Medicine, concluding that cannabinoids hold great promise. “Although the exact mechanism is not understood, in some models, cannabinoids have shown to decrease cancer cell growth and invasion,” suggesting further investigation is warranted.

THC is often credited with reducing pain, increasing appetite and helping with sleep. Numerous publications address the potential health benefits of THC for people with cancer and other health conditions.

CBD oil is known for its anti-inflammatory properties, which may ease the symptoms characteristic of diseases like pancreatitis and arthritis. CBD-infused products such as gummies, tinctures and topical ointments may be effective for reducing stress, pain and anxiety.

Does Medicare Cover Medical Marijuana?

Medicare covers prescription drugs under Part D. Part D includes coverage for medications prescribed for you to take at home and are purchased at a pharmacy. Limited drugs administered by a medical provider in an outpatient setting may be covered under Medicare Part B.

Medicare does not cover botanical THC or CBD products like CBD oil and CBD gummies. If you are wondering, why doesn’t Medicare cover medical weed, Medicare only covers drugs that are approved by the Federal Drug Administration (FDA). The U.S Drug Enforcement Administration (DEA) classifies marijuana (cannabis) as a Schedule 1 drug, a class of “drugs with no currently accepted medical use and a high potential for abuse.”

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Why is Marijuana Prescribed by Doctors?

Some doctors recommend medical marijuana for patients receiving limited benefits from prescription drugs. There are also healthcare practitioners who favor using alternative medicine and holistic products that are natural versus chemical.

Your doctor may work with you to apply for a medical marijuana card so that you can register with a dispensary and buy marijuana products. If your state approves the application, you will receive a registration certificate that you must present at the dispensary you’ve selected.

Medical marijuana dispensaries have resident pharmacists who can guide you in choosing the products that address your symptoms. Both THC and CBD products come in a variety of forms like capsules, edibles, dried leaves, tinctures and topical solutions.

Some doctors are reluctant to certify patients for the medical marijuana program, and the Department of Consumer Protection does not mandate that healthcare practitioners recognize marijuana for medical treatment.

When Your Doctor Recommends Medical Marijuana

The National Institute on Drug Abuse (NIDA) states that “THC itself has proven medical benefits in particular formations” and some doctors agree. According to the NIDA, “researchers generally consider medications like these, which use purified chemicals derived from or based in the marijuana plant, to be more promising therapeutically than use of the whole marijuana plant or its crude extracts.”

To alleviate nausea in cancer patients and poor appetite in AIDS patients, a doctor may prescribe the following THC-based drugs:

• Dronabinol (Syndros, Marinol)
• Nabilone (Cesamet)

A doctor may prescribe Epidiolex, a liquid medication with a CBD component, for children who have:

• Epilepsy
• Dravet syndrome
• Lennox-Gastaut

Getting encouragement from your doctor to try THC products begs the question, does Medicare pay for medical marijuana in some cases?

There are synthetic FDA-approved drugs that are THC- or CBD-based that Medicare Part D may cover with a doctor’s prescription, depending on the formulary included in your Medicare prescription drug plan. Stand-alone Prescription Drug Plans and Medicare Advantage plans that include prescription drug coverage have their own formularies or lists of covered drugs.

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How Much Does Medical Marijuana Cost?

The cost of Part D medications varies with the prescription drug plan you have enrolled in. Variables include your deductible, coinsurance and the designated drug tier on your formulary (approved drug list).

Marijuana products you purchase at the dispensary tend to be costly. The cost of naturally grown products is influenced by the weather and access to growers.

There is also the cost of the medical marijuana card itself, which varies with the state. A medical marijuana card can range from $0 to over $150 per year, according to an NBC news report in 2021, with the average cost running around $75.

Marijuana Legalization

The number of states legalizing marijuana is growing. States that have legalized marijuana for both recreational and medicinal purposes include:

• Alaska
• Arizona
• California
• Colorado
• Connecticut
• District of Columbia
• Illinois
• Maine
• Massachusetts
• Michigan
• Montana
• Nevada
• New Jersey
• New Mexico
• New York
• Oregon
• Rhode Island
• Vermont
• Virginia
• Washington

Even in states where marijuana is legal, there are towns that will not allow dispensaries to set up shop.

Check your state and local regulations to determine if a dispensary is available in your area. It’s also a good idea to discuss with your doctor the pros and cons of medical marijuana-specific to your health condition.

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