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01-10-2013 Health Coverage Unlikely to Reimburse Patient's Use of Medicinal Marijuana

The legalization of marijuana for medicinal purposes in certain states has sparked debate over whether the drug should be covered by an individual's healthcare prescription plan. Currently, eighteen states plus the District of Columbia permit an individual to obtain a prescription for marijuana in order to alleviate symptoms associated with diseases such as cancer, AIDS, and multiple sclerosis. However, no private insurer or Medicare currently covers a patient's medicinal marijuana prescription.

Despite its legalization in many states, marijuana is still illegal at the federal level. The Drug Enforcement Administration ("DEA") classifies the drug as a Schedule 1 controlled substance, the same classification given to heroin and LSD. Likewise, marijuana has not yet been approved by the Food and Drug Administration ("FDA"). Because it lacks clear components or standardized doses, the drug is an unlikely candidate for the FDA's rigorous approval process. Without a change in the DEA's classification of marijuana and subsequent FDA approval, health insurance providers will not cover its use.

Current law in certain states declares that a health insurance provider faces no liability for refusing to cover the costs of medicinal marijuana. For example, an Alaska law states that a health insurance provider is not liable for any reimbursement claim for expenses associated with the medical use of marijuana.

In October 2012, a three-judge panel for the U.S. Circuit Court of Appeals for the D.C. Circuit heard arguments from Americans for Safe Access, a marijuana advocacy group petitioning the DEA to reconsider its classification of marijuana as a Schedule 1 substance. The group hopes to secure a Schedule 2 classification, meaning the federal government would recognize marijuana as having some accepted medical use. A change in classification would increase the probability that the FDA would conduct further research, ultimately making it a stronger candidate for FDA approval and health insurance coverage. The result of that case, Americans for Safe Access v. Drug Enforcement Administration, is pending.

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This article is provided by Fraser Stryker for general informational purposes and is not intended to be and should not be construed as legal advice on any specific facts or circumstances.

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