Although the landscape is set to change dramatically with the legalization of marijuana for recreational use, plan sponsors and members can expect a distinct system for medical cannabis to continue, said Aurora Cannabis Inc.’s Jonathan Zaid.
Speaking at the Pharmacy Solutions in Drug Plan Management forum in Mississauga, Ont. on Sept. 25, Zaid, the organization’s director, advocacy and corporate social responsibility, said the government has been clear that post-legalization, it’s committed to a separate medical cannabis system similar to the current production and distribution regime, the Access to Cannabis for Medical Purposes Regulations, which were created in 2016.
“I think it’s important to have a distinction between medical authorized cannabis to ensure that patients are using it as part of their overall treatment plan, and benefits coverage and other support mechanisms can be in place for people with, often, chronic and complex health conditions,” he said.
Under the pre-Oct. 17 regulations, all authorizations for cannabis went through a health-care provider, who issued a medical document similar to a prescription. Safety testing and quality control, including potency, was carried out, and individuals were permitted to possess the lesser of 30-times their daily authorized dose or 150 grams.
The patient was also required to place the order directly with a licensed commercial producer, register with Health Canada to produce a limited amount of cannabis for their own medical use or designate someone to produce it for them.
To date, Canada has seen nearly 300,000 ACMPR registrations, as well as 13,350 unique health-care provider authorizations, said Zaid, as patients treat a number of medical conditions with cannabis, including mental-health symptoms, cancer and chronic pain, using an average dose of 2.1 grams per day.
“The health-care provider authorization numbers have grown consistently, which is really encouraging to see more and more health-care providers get involved in the medical cannabis space and start prescribing,” said Zaid.
At the same time, October’s legislation allowing adults in Canada to legally purchase cannabis for non-medical purposes also brings a few changes for the medical cannabis space, such as packaging and labeling requirements, the ability for patients to switch producers and no possession limits at their place of residence, he said.
Although medical cannabis won’t yet be dispensed by pharmacists, advocacy is ongoing in this area, according to Zaid.
The new legislation also brings a number of responsibilities on the workplace side, he said, noting employers are required to ensure safety, and also have a duty to accommodate employees’ medical cannabis use to the point of undue hardship.
He suggested employers start by creating an effective, four-part drug and alcohol policy, which covers legal, non-medical substances, prescription substances and illegal substances. This will allow “an individual case-by-case assessment to occur and the appropriate accommodations or actions based on that individual’s use.”
Similarly, Zaid underscored the employer’s responsibility to understand the duty to accommodate an employee’s medical cannabis use and consider each situation on a case-by-case basis.
Although, on the benefits side, coverage may have been slow in the past due to lack of a drug identification number, as well as some stigma around medical cannabis use from employers and plan sponsors, Zaid noted that in the last year or two, a number of licensed producers have added product identification numbers to medical cannabis, which has allowed for easier claims processing and adjudication.
The advantages of coverage, he said, are potential cost reductions if patients are substituting medical cannabis for more expensive drugs, or taking less sick time.
“Lots of employees are asking for medical cannabis coverage, and it also protects from human rights complaints, which we’ve seen a number of launched and most likely [will] continue to be an area where patients will advocate.”
At the same time, noted Zaid, there may still be risks to covering cannabis in a benefits plan, including safety, potential litigation and increased costs, depending on substitution.
Four ways in which benefits plans have approached cannabis to date include by individual employee assessment; general health-care spending account; a separate health-care spending account for medical cannabis expenses; and broad coverage for any employee with a prescription for medical cannabis, which a large number of employers have opted for.
Each have pros and cons in terms of costs and administration, said Zaid. “It’s necessary to approach this in a responsible way, but I don’t think it’s something that we can continue to avoid, so it’s great to see a number of carriers and plan sponsors move to this.”
Read more articles from the 2018 Pharmacy Solutions in Drug Plan Management Forum