Why Does Health Insurance Reimburse You for Opioids But Not for Medical Marijuana?

opioids or marijuana from health insurance

The introduction of cannabis on a mainstream level in many states in the US has answered some questions on a medical level. It has also provided help to the economy and other issues in the community. One example is the opioid epidemic that has greatly impacted many, particularly in the US. The opioid epidemic started as physicians prescribed opioid-based treatments for many ailments. As more Americans relied on opioids which has a high threshold for dependence, the addiction grew. Addiction to opioids grew on a general scale creating an epidemic further requiring another series of treatments as well. The eventual treatment needed for the addiction to opioids gradually became more expensive than the medicine for the ailment itself.

Medical marijuana offers a turning point to the general issue of the opioid epidemic. The growth of the use of cannabis for some of the conditions that opioids are used for has had an effect in slowing the epidemic. More states are opening their borders to marijuana by putting in place favorable laws to limit the use of opioids. Cannabis has been identified to be useful in ensuring relief from pain, inflammation, and other ailments. This has fostered the expansion of medical marijuana programs in some states and some countries as well. Marijuana does not have the level of dependence issues that plague opioids. It also does not have some of the unwanted side effects of opioids making it more acceptable.

Despite the obvious potential and use of medical marijuana, there is still a major issue of legalization and regulation that creates a big cloud over the sector. This has pushed some corporate entities such as insurers and banks to the fence as it limits the extent of their interaction with players in the industry. This is the reality as health insurers are more likely to reimburse you for opioids but not for medical marijuana. A country like Canada has this issue as insurers offer little to no coverage options for patients looking to use medical marijuana to attend to their ailments. Patients are left with the undesirable choice of choosing opioid-based treatments and be covered or choose medical marijuana and pay for the cost. This disturbing issue creates a bit of a dilemma for users of medical marijuana who see it as a better alternative to opioid-based treatments but need the coverage offered by health insurers.

There are different reasons that have handicapped health insurers from being able to provide coverage for medical marijuana users. Here is a closer look into some of those reasons.

Regulation and laws

There is no major limiting factor restricting health insurers and banks like the issue of regulation around cannabis. Despite the fact that more states are legalizing the medical and recreational use of cannabis, it is still regarded as illegal on a federal level. Cannabis is classified as a Schedule I narcotic drug which means it is of no medicinal use and has a very high degree of dependence. Though many will agree to the fact that this designation of cannabis is not right, it is still the current state of things. Many insurance providers will not want to be at loggerheads with the federal government which is why they have held back majorly until regulation changes.

The different laws that guide medical marijuana are very much peculiar to different states. This creates a dilemma for health insurers, banks, and other industries as they seek to justle between legal and illegal states and issues surrounding laws.

Lack of sufficient medical studies on cannabis

The issue of relevant studies has always been a problem surrounding medical marijuana. It has also proven to be a yardstick being used by many health insurers to justify the lack of coverage for medical marijuana users. For much of the beneficial claims of cannabis, there is still limited clinical evidence to boost the growing good graces of medical marijuana use. This reality is sure to change in not time as sufficient studies and researches are already being carried to elucidate the true extent of potentials in cannabis. Unfortunately, this still provides a huge problem for those that are presently in need of coverage for medical marijuana.


One unexpected reason that is holding back health insurance for medical marijuana is the issue of cost. Medical marijuana has a higher associated cost total compared to opioids treatment. An example of this can be seen in the breakdown of the numbers for Canadian Veterans Affairs (VA). The body spent over C$ 409,000 in terms of coverage in the year 2014. Fast forward to between 2016 to 2017 the body spent over C$ 63.7 million for coverage. This helped insurance providers to conclude that there is a huge spike in medical cannabis costs. With the other issues of regulations, laws, and lack of evidence, most insurers are not willing to risk offering coverage for medical marijuana.

There have been rare cases where limited coverage has been offered for users of medical marijuana in the US. Though most of these cases fall under compensation for workers and not insurance yet they show instances of coverage that could still increase with fewer restraints. Two separate cases have happened in New Jersey where workers have been injured on the job and employers covered their medical marijuana costs. Unfortunately, this is not the same as what is on the cards for many in terms of coverage for medical marijuana costs.

Bottom line

The effectiveness and use of medical marijuana is not in question, however, the readiness of insurance providers to take risks are.  Understandably, many of these risks are outside the influence of the insurance providers. However, they create a problem when patients are not offered coverage for medical marijuana but the opposite is the case for a lesser alternative like opioid-based treatments. Hopefully, things will change in sooner rather than later especially in the aspect of regulation and laws. Pending that reality, the situation remains that insurance providers do not provide reimbursement for medical marijuana patients; which shouldn’t be happening in 2021.










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