CannabisCoverage - Private Insurance Plans

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To date medical marijuana is not listed on the benefit formulary of any third-party insurer (private insurer).  Most private insurance plans have an additional list of special authorization / prior authorization medications that are covered in specific circumstances but medical marijuana is not currently on these lists.  Private insurance plans which have a health spending account (HSA) component can cover medical marijuana and most HSAs do cover medical marijuana.  There have been a few isolated cases where patients have been able to get reimbursement for medical marijuana costs through their employer-provided drug  benefits plan (special authorization / prior authorization mechanism).  These have been compelling cases where the standard-of-care pharmaceutical therapies have been ineffective and where medical marijuana has shown clear benefit.  Most importantly these were cases where the the provider of the plan (the employer, association, etc) has been supportive of the claim and has given the insurance provider instruction to cover the costs of mdical marijuana for the individual, as a one-off exception to the drug benefit plan.

Making a Prior Authorization / Special Authorizartion Request

You will need to submit 2 documents (together) to your insurer:

  • a special authorization / prior authorization form.  You can access this on-line from your insurer's website (client forms section).  Alternately you can fill out the fields below to generate a special authorization / prior authorization form (the insurer provided form is preferable)
  • a letter from your physician stating your diagnosis and symptoms, giving details of your treatment to date, including pharmaceutical therapies, and the treatment outcome, the medical rational for using marijuana, results of using marijuana (if patient already using it), dose, duration, etc.  Supporting published scientific/ medical literature should also be included. Physicians can access information and tools to simplify this process by enrolling here .  There is no fee or charge for this service and it is only available to healthcare professionals who are authorized to prescribe medical marijuana.

 Prior Authorization / Special Authorizartion Request Form (note: the insurer provided form is preferable - check with your insurer for their form first)