By: Jay Krueger, Chief Strategy and Client Services Officer, PMSI
A debate has arisen in the medical community regarding the appropriateness of medical marijuana in treating pain. Proponents claim that it is not as harmful or addictive as the most common pain medications and is effective in treating pain that is not responsive to other therapies. Several organizations within the medical community have publicly endorsed the use of marijuana for its medical potential, including the American Academy of Family Physicians, the American Public Health Association, the American Nurses Association, the American College of Physicians, and the New England Journal of Medicine. Others side with the federal government who, in 1970, classified marijuana as a Schedule I substance, making obtaining and using marijuana for any purpose a federal offense.
Since this time, 16 states and Washington D.C. have legalized the use of medical marijuana. This divergence between the federal government and state governments presents a challenge for the workers’ compensation industry, as many claims involve the treatment of pain. Even in states where use may be legal, use in the workplace is not protected and may prevent an injured worker from returning to work. Additionally, many patients experience side effects which may hinder or impair performance of regular work duties. These factors cause employers to continue to struggle with allowing the use of a federally illegal substance for purported medicinal purposes that may be legal in the state of jurisdiction.
In 1996, California made waves when it legalized the use of medical marijuana – the first state to do so. This month, marijuana is back in the news as the California Supreme Court is involved with the conflict between state and federal laws over use and sale of the drug. Although the state has legalized the possession of marijuana for medical purposes (8 usable ounces, up to 18 plants), the federal government has taken aggressive enforcement actions against California growers and owners of dispensaries, causing a host of lawsuits. Interestingly, California lawmakers have introduced a bill that would make employee termination due to medical marijuana use an act of discrimination; although, a final ruling has yet to be made.
One barrier to the coverage of medical marijuana by insurance plans is that the Centers for Medicare and Medicaid Services (CMS) will not provide payment for products or services if a provider does not comply with federal law; hence, the lack of reimbursement for medical marijuana. Furthermore, the Schedule I status of marijuana prohibits the assigning of a National Drug Code (NDC) to these substances, increasing the difficulty for Pharmacy Benefit Managers (PBMs) to process medical marijuana transactions. This is complicated by the fact that there has yet to be a workers’ compensation case related to the compensability of medical marijuana in treating a workplace injury.
Although proponents of legalizing marijuana for medicinal purposes continue to cite potential benefits, particularly in the chronic pain population, there is a lack of substantial clinical data evaluating the safety and efficacy of this treatment approach. For the time being, insurers are advised to carefully evaluate their position on the matter and draft appropriate policies regarding their decision on the coverage/status of marijuana for medicinal purposes. As more and more states approve marijuana usage, this issue is likely to grow in the coming years.
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About Jay Krueger
As Chief Strategy and Client Services Officer, Jay Krueger provides the overall strategic direction of PMSI, Inc., a leading provider of cost containment solutions for the workers’ compensation industry. PMSI operates as one of the largest specialty services providers for Pharmacy Benefit Management (PBM), Durable Medical Equipment, Home Health Care and Case Settlement Services. With nearly 15 years of experience in healthcare and workers’ compensation markets, Jay leads the company’s product development, clinical, marketing government affairs, and client services functions.
Founded in 1976, PMSI is a leader in developing solutions to control the growth of medical costs in workers’ compensation. As one of the nation’s largest and most experienced companies focused solely on workers’ compensation, we deliver proven solutions for cost containment across the claims lifecycle. PMSI’s solutions for Pharmacy, Medical Services and Equipment, and Settlement Solutions deliver quantifiable results and improve the quality of care for injured workers. We provide our customers with the innovation, focus, expertise, analytics and technology needed to successfully deliver workers’ compensation benefits.
For more information on PMSI, visit: www.PMSIonline.com
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