Cannabis Coverage - Insurance Providers

Insurance
Providers Employers /
Unions Health Spending Accounts Provincial, Territorial & Fedral Drug Plans Claiming on Your Tax Return

Health Benefits Plan Sponsors (employers, unions, associations who provide health benefits plans for their employees/ members) usually include coverage for outpatient medications. These plans provide access to prescription medications as well as non-prescription medications and medical devices. The plan sponsor usually uses a third party (an insurance provider ) to provide coverage of medications for its employees. Not all medications are covered and usually the plan sponsor decides on what medications will be covered. How plan sponsors make this decision is by choosing from a number of drug / medication plans offered by the various insurance providers. Each plan has a formulary of medications covered by the plan. A plan sponsor can customize a plan or formulary for its members and can add individual medications (prescription and non-prescription medications and natural health products) to the plan. A number of insurance providers have made medical cannabis / medical marijuana available on a formulary available to plan sponsors. When available, coverage is subject to usage criteria and other plan restrictions. In addition to coverage through the formulary mechanism, some plans have a Health Spending Account (HSA) component. A HSA 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. Eligible expenses are defined as a list of medical expenses or as the Canada Revenue Agency (CRA) list of eligible medical expenses. Medical marijuana is listed as an eligible expense in many company HSAs and is on the CRA list of eligible medical expenses.

Insurance Provider	Coverage Details updated March 14, 2019	Provider Medical Cannabis Information / Forms
Alberta Blue Cross	through Health Spending Account only
Co-Operators Life Insurance Co.	chronic pain associated with identified medical conditions muscle spasticity in multiple sclerosis (MS) chemotherapy-induced nausea and vomiting Prior Authorization required
Desjardins Insurance	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 21 years or older plus Prior Authorization required
Green Shield Canada	chronic neuropathic pain multiple sclerosis related spasticity nausea and vomiting due to cancer chemotherapy must be 25 years or older and have already tried and failed standard treatments
Great West Life	no specific disease related criteria. Each case reviewed individually prior authorization form must be submitted
Markers Financial	no specific disease related criteria or restrictions. Each case reviewed individually
Manulife	stiffness and involuntary muscle spasms in people suffering from Multiple Sclerosis nausea and vomiting in people undergoing chemotherapy chronic neuropathic pain prior authorization required partnered with Shoppers Drug Mart to deliver the medical cannabis program
Medavie Blue Cross	chronic neuropathic pain refractory pain in palliative cancer nausea and vomiting due to cancer chemotherapy spasticity in multiple sclerosis or spinal cord injury Prior Authorization required
SSQ Insurance	chronic neuropathic pain cancer related pain spasticity secondary to multiple sclerosis or spinal cord injury nausea and vomiting causer by chemotherapy Prior Authorization required use after traditional prescription drugs deemed ineffective
SunLife Financial	severe pain with cancer, or nausea and vomiting with cancer treatments. spasticity or neuropathic pain, with multiple sclerosis. rheumatoid arthritis, when all other standard treatments have failed. anorexia or neuropathic pain, with HIV/AIDS. palliative care Prior Authorization required