The average medical marijuana patient likely uses less of the drug than prescribers think, according to an industry participant whose company has experience with coverage under its benefits plan.

Speaking at an event held by Aon Hewitt in Toronto on Wednesday, Jonathan Tafler, senior director of product and operations for employer health solutions at Shoppers Drug Mart Inc., discussed the company’s experience since it added medical marijuana coverage to its employee benefits plan for certain conditions, such as nausea and vomiting related to chemotherapy. As part of the new benefit, the company introduced a coverage limit of $1,500 per year, an amount Tafler said might differ from other industry estimates of annual costs for the drug.

“What we found, though, is that in actual fact, while prescribers are prescribing . . . on an average of 2.3 grams per day, what we’re finding is that the usage is actually less than a gram a day on balance, certainly for those indications but also for others. The average usage has been around 0.7 grams per day and, with the proper agreements with suppliers and proper pricing controls, actually that lands at more of a $2,000 per annum cost for an employee. So we thought $1,500 maximum without co-pay was a reasonable starting point in that regard,” he said.

Read: Shoppers, Loblaw introduce medical marijuana into benefits plan

The Shoppers Drug Mart experience was among two case studies discussed at the event. Also speaking at the event was Lucian Schulte, senior vice-president and national analytics and innovation leader at Aon Hewitt. He spoke about a client that was taking a wait-and-see approach to covering the drug.

Schulte said his client opted to hold back due to a lack of requests for the drug, challenges around determining how to cover it and questions about prescribing. Costs were also a concern, as were the company’s existing wellness strategies, he said.

“So the primary delivery method for cannabis typically is through combustion, through smoking. And the plan currently has a strong emphasis on wellness and non-smoking and smoking cessation therapies. And so when we looked at if we were to not cover potentially dried cannabis and look at cannabis oils as potentially an alternative, the cost for cannabis oils is anywhere from 40 to 100 per cent more than dried cannabis,” said Schulte.

Read: Workplace safety leading HR issue as marijuana legalization approaches: HRPA

Schulte noted his client is also waiting to see if other products will come to Canada, such as an inhaler currently at the trial stage in Israel that doesn’t combust the marijuana and allows for exact dosing.

In Shoppers Drug Mart’s case, the company wanted to make the drug available based on its clinical merits and a feeling that there’s a medical need, said Tafler.

Another reason, he noted, was a number of studies showing how medical cannabis led to significant reductions in opioid prescribing.

“They’ve shown as much as a 30 per cent reduction in opioid prescribing. It’s been very public in Canada, the harms of opioid use and abuse, and so if we can reduce that through a safer, more effective treatment, I think that the onus is on us as employers and the insurance industry to do that,” he said.

“And in addition, from a cost perspective, because medical marijuana isn’t free, we look at offsetting the cost of our investment in that . . . with reduction in other prescribing. And it’s not a small bucket. Depending on your plan, you could be seeing opioid use in the three to six per cent range in terms of the total cost to your plan. We’re talking hundreds of millions of dollars in Canada spent on opioids by private plans.”

Read: CLHIA warns of unintended consequences in Health Canada’s proposed pot rules

One the company made a decision to cover the drug, it had a number of other issues to consider, Tafler noted. They included which criteria to use to approve or deny coverage, how the plan would be certain a claim is for true medical use and developing processes to administer the benefit.

The company also had to address human resources issues, including the code of conduct and policies around fitness for duty, substance abuse and smoking. “We found it was more tweaks than a full redrafting of those policies,” said Tafler.

He noted claim volume has been lower than expected, which he attributed to a conservative cost methodology and awareness.

“What we hear from our care partners is awareness of a benefit. Any new benefit typically takes several years for your plan members to be aware of, so we may be seeing a bit of a lag effect,” he said.

Copyright © 2021 Transcontinental Media G.P. Originally published on

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