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Marijuana and Medicare

July 12, 2021

Stethoscope And Marijuana Leaf

This information has been reposted here with permission from Retire Guide

Does Medicare Cover Medical Marijuana?

Medical marijuana is legal in some states, but Medicare will not cover it because it is considered an illegal schedule one drug by the federal government. However, some cannabinoid medications may be covered by Medicare Part D or Medicare Advantage plans.

Why Isn’t Medical Marijuana Covered by Medicare?

Medicare will cover only medications approved by the Food and Drug Administration.  Medical marijuana isn’t FDA-approved, and it is still considered an illegal drug by the federal government.  Therefore, Medicare won’t cover the cost of purchasing a medical marijuana card or buying medical marijuana at a dispensary.  This is true even if you live in a state where medical marijuana is legal.

However, certain cannabinoid medications — such as Syndros and Epidiolex — may be covered by Medicare drug plans because these products are FDA-approved.

Four Cannabinoid Medications Are FDA-Approved

The marijuana plant contains more than 60 different types of cannabinoids. Two cannabinoids have been studied for medicinal uses: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

Medical marijuana may not be FDA-approved, but four cannabinoid medications are.

Other than the four products listed below, the FDA has not approved any other cannabis, cannabis-derived or CBD products on the market.

Cannabinoid Medications Approved by the FDA

Epidiolex

Epidiolex contains a purified form of CBD and is used to treat seizures associated with Lennox-Gastaut syndrome and Dravet syndrome.

Marinol

Marinol is approved to treat nausea associated with cancer chemotherapy and weight loss in AIDS patients. It is a synthetic cannabis-related compound available in capsule form.

Syndros

Similar to Marinol, Syndros is prescribed to treat nausea associated with cancer chemotherapy and weight loss in people with AIDS. Syndros is a synthetic cannabis-related compound available in liquid form.

Cesamet

The active ingredient in Cesamet is nabilone, a synthetically derived chemical structure similar to THC. It is used to treat nausea associated with cancer chemotherapy. It is available in capsule form.

Medicare Cost and Coverage of Cannabinoid Medications

The fact that these four drugs are FDA-approved doesn’t mean Medicare will cover the cost.

As a quick reminder, there are two ways to receive Medicare prescription drug coverage:

  1. A standalone Medicare Part D prescription drug plan.
  2. A Medicare Advantage plan with prescription drug coverage.

Medicare’s coverage of cannabinoid medications depends on the type of prescription drug plan you have.

For example, GoodRX, a health care company that tracks prescription drug prices in the United States, notes that most Medicare plans will not cover Syndros.

Because Syndros is a name-brand drug, it is quite expensive without insurance coverage. GoodRx estimates a single prescription of Syndros can cost up to $1,342.

However, some Part D and Medicare Advantage plans will cover part of the cost of Syndros.

For example, Independent Health is an insurance company that offers six Medicare Advantage plans.

All six cover Syndros as a Tier 4 drug, according to the company’s 2020 Individual Part D Formulary.

Syndros has an estimated $40 copay with plans from Independent Health, according to GoodRx. Plan deductibles may also apply.

It’s important to note that even if your Part D or Medicare Advantage plan covers cannabinoid medications, you may still need to get prior authorization. This means you need to contact your plan in advance and your health care provider may need to fill out paperwork describing why you need the prescription.

This is only an example. Medicare Advantage and Part D plans tend to serve specific coverage areas. Independent Health, for example, is available only in eight counties in Western New York.

It’s important to check your own plan details and formulary to see if cannabinoid medications are covered.

The following information is presented for educational purposes only. Summit Releaf distributes this information to provide an understanding of the potential benefits of medical marijuana for patients living with one of the approved Ohio Medical Marijuana Control Program qualifying conditions for an Ohio marijuana card. Links to third party websites do not constitute an endorsement of these organizations by Summit Releaf and none should be inferred.

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