How three benefits plan members are receiving medical cannabis coverage

While medical cannabis coverage is appearing in more benefits plans, most insurers that cover it still have very specific conditions.

Sun Life Canada covers the most conditions, at seven, after adding two ailments to its roster in 2019. Marie-Chantal Côté, the insurer’s vice-president of market development for group benefits, says evidence is emerging that shows cannabis provides users with relief and helps them live healthier lives, citing the connection between physical pain and the impact on mental health, as well as disability management.

“We’re finding every plan member has a very unique experience and journey and their treatment plan is very personalized.”

Read: Sun Life adding medical marijuana coverage to group benefits plans

As well, many employers, big and small, are joining the conversation on whether to include it in their benefits plans. Perhaps unsurprisingly, licensed producer Aurora Cannabis Inc. was an early adopter of the benefit. Through its insurer, the company reimburses plan members up to a set cap, says Kym Purchase, director of government relations. She notes it’s important for Aurora that proper approvals for the treatment are met, but with as little friction as possible so plan members don’t find the process onerous.

“If a doctor and patient have engaged in a relationship whereby medical cannabis seems to be appropriate for their care, that’s a pretty important consideration for us. While there are other things that people could potentially take, if this is considered to be important to their care, it’s important that we honour that choice and remove barriers for our employees to access it.”

With insurers and plan sponsors increasingly incorporating medical cannabis into the realm of employee well-being, Benefits Canada spoke to three plan members who are using the drug and claiming it through their workplace benefits.

Kate Trozzi

Kate Trozzi never expected to have to navigate the complex world of pain management.

In 2010, while working in logistics for the Canadian Armed Forces, she fell 20 feet during a training exercise, sustaining an impact injury that significantly damaged her right arm, neck and spine.

By the numbers

27% of Canadians using cannabis for medical purposes said they have the proper documentation from a health-care provider.

61% said using medical cannabis has allowed them to reduce the need for other medications.

35% said they use it daily, while 15% use it less than once a month,15% do so two or three times a month, 11% said two or three days a week and another 11% said four or five days a week.

Source: Statistics Canada, 2019

After a medical release, the 31-year-old has been on a long-term disability claim, enduring ongoing surgeries as she waits for a replacement donor elbow. “It’s been determined through multiple assessments that I will not be able to return to work,” she says. “The mobility of my right arm is questionable; there are days where I can’t lift it or use my arm to brush my hair.”

Read: A look at medical cannabis coverage’s growing pains

Since the accident, Trozzi has sought to manage her pain in a number of ways. “The past 10 years has just been me trying to figure out how to be disabled and how to function as best I can.”

While solutions like physiotherapeutic massage and osteopathic treatments have made a major difference, she says others haven’t been as successful. “I went to a pain clinic in Toronto for approximately six months where I had weekly injections, about 26 injections a week of different steroids, which only made me extremely ill. And we ceased six months in because it didn’t help and it exacerbated some of the problems which led to another surgery.”

For several years, managing the pain has also meant using strong prescription painkillers, trying many different drugs over time. While these have been effective in some ways, Trozzi says they hurt her quality of life in others.

“It was like being in a stupor where I knew I was in pain, but I was too high to care. . . . I was no longer myself. . . . It really does alter your state of being and I felt like I couldn’t function like a human. I couldn’t go out and just get a coffee and maintain normal conversation. At the time, I didn’t have children; there was no possible way, in my mind, that it would have been possible.”

Trozzi also experienced severe anxiety and post-traumatic stress disorder, which often caused her serious nausea. She heard about other disabled veterans receiving cannabinoid treatments for mental-health issues through the armed forces and thought it might be an option to address some of her own.

Read: Veterans Affairs urged to better manage drug plan, marijuana costs

“I came to my doctor about it. I had taken myself off percocet and morphine, so I was just trying to manage my pain with all of the other resources at my disposal and she was really supportive. I was referred to a medical marijuana clinic where I met with a doctor who talked to me about my disability and my mental health because I do have diagnosed PTSD from my accident. We decided it would be helpful for me to try. And then she talked to me about different types of strains [and] the different effects.”

Through Blue Cross, Veterans Affairs Canada covers two grams of medical cannabis a day. Trozzi uses about half of this amount, unless she’s having a particularly bad flare up or is recovering from surgery. She finds using it in oil form works best for her since she’s not entirely comfortable with smoking. And she tends toward strains with a high percentage of cannabidiol, more commonly known as CBD, which is typically associated with easing pain and anxiety, rather than tetrahydrocannabinol, or THC, which is the main psychoactive compound in cannabis.

She’s also now the mother of two. “I’m able to do things like go outside with them and have the energy to keep an eye on them or have energy to take them on a walk because my energy isn’t being expended trying to manage my pain.”

Ron Hilverda

Prescription pain medications were, and still are, part of Ron Hilverda’s journey with a disability from a lifting injury he incurred in 2012 during his work as an automobile transmission technician.

Disability coverage from his employer came and went. Since he’d suffered a soft-tissue injury, it was unclear why his pain persisted. In 2015, he eventually underwent surgery and connected with multiple specialists to address his chronic pain.

Read: Sounding Board: How to deal with medical marijuana in the workplace

A local pain specialist who noticed Hilverda wasn’t responding well to traditional pharmaceuticals was the first person to suggest that alternatives might be a better route. “That, for me, was the start of whether or not I would consider it. I’d gone through three to four years of hell with the way I was feeling.”

He bounced around, connecting with several doctors and finally tried medical cannabis for the first time in 2016, paying out of pocket for all of his appointments and licensing. “At the time, a licence for medical cannabis was about $300. I bought a vaporizer, which is how I administer the dry flower. I don’t smoke joints. The vaporizer is a lot healthier . . . and I use edibles and oils.”

It took Hilverda some time to get used to using cannabis. “I have lots of friends who used cannabis in school, but it was something I was fundamentally opposed to. I was raised in a strict Christian home and so with those values . . . it was very hard to change my mind.

“But [I was] living in a personal hell with pain and suffering for years; the medication the doctors prescribed didn’t work and I had poor reactions to it. And they’d say, ‘Well, you’ve got to be on it for longer than a month . . . , you have to be on it for three months, then in the interim you’re physically sick and unwell from side-effects from the drug and I could barely cope some days with my own symptoms. So taking a prescription medication just wasn’t working for me at all.”

Prescription painkillers also impacted Hilverda’s mental health by making it more difficult for him to control his emotions. “I had horrible mood swings.”

After a long process with WorkSafe B.C., his medical cannabis is finally covered, but only partially. Earlier this year, the organization said it would remunerate him retroactively to 2018, but only for the CBD portion of his treatment.

Read: What’s the impact of medical marijuana on patients, drug plans?

The lack of negative side-effects is one of the most important changes to Hilverda’s quality of life since he started using cannabis. “I mix up my day with different strains of cannabis depending on what I’m doing and how I’m feeling. I will vaporize between three and six times a day with usually a different strain every time.”

And this method of using cannabis in small bursts throughout the day gives the 57-year-old control over his symptoms and enables him to feel well enough to do everyday things like visiting the park, running errands or having important household discussions with his wife.

“We can talk about something that I wouldn’t normally be able to talk about when I was on prescription medications, which is overwhelming, and it would just be beyond my mental capacity. . . . Now, it’s like, ‘Give me 20 minutes and then we can talk about it.’”

Jeremy Smith

As a teacher in a large Ontario school district, Jeremy Smith (not his real name), 46, feels the pressure of the stigma associated with medical cannabis use.

After about 10 years in another job, he returned to teaching, which led to heightened anxiety. Mentally, teachers can have trouble getting out of a work mindset in their downtime, he says. “You teach during the day and in the evening, you’re always thinking about the next day, what you’re going to teach, what you covered, what you missed, which students need extra help, so it can produce heightened anxiety.”

Read: Employer obligations around medical pot, benefits plans

Smith has seen a psychiatrist almost monthly for over a decade for anxiety and depression. During one session, he discussed his recreational cannabis use. The psychiatrist suggested that, instead of using a recreational supply for relaxation, he could write a prescription and fold it into his other treatments.

At first Smith was dubious, but he wasn’t completely happy with his prescribed medications; they made him drowsy, some to the point where he didn’t feel safe to drive. So he gave cannabis a try in a medical context.

Key takeaways

• The benefits industry is making headway in researching and covering medical cannabis for certain conditions, but it still has a long way to go.

• Medical cannabis can fit into a broader health management plan, rather than being the sole solution for a plan member’s condition.

• Whether medical cannabis makes sense for a plan member depends on their unique circumstances and won’t work for everyone in any form.

His prescription was a combination of CBD, which he took orally in oil form, often starting with a dose in the morning and then another at lunch as needed. He found the daytime CBD use helped banish nagging anxious thoughts without the side-effects of others prescriptions. In the evenings, he used dried flower in a light THC strain with a vaporizer to help him decompress from the day’s work.

Initially, Smith paid out of pocket for his medical cannabis. But then, his local union arranged for a temporary, three-month health-care spending account through a benefits provider. “I saw on the list of expenses that [it] was covering medical cannabis . . . in the health-care spending account. So after providing documentation of my prescription, I was able to claim it.”

Read: Medical questions, regulations create confusion for medical pot coverage

The $1,500 in the account more than covered his usage. Typically, he’d order in bulk, up to an ounce for the flower, and space his use out over several months.

As Smith has gotten back into the swing of teaching, his anxiety has reduced drastically, to the point where he didn’t renew his prescription at the beginning of 2020. But he greatly valued the coverage through his workplace benefits when he did need it.

“It was really helpful at the time. . . . I think it actually helped, in some ways, more than the medications I was prescribed.”

Martha Porado is a former associate editor at Benefits Canada.