Updated on November 22, 2021.
Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
The New York State Department of Financial Services, Health Bureau, recently clarified insurance law concerning medical marijuana in the state. Insurers will now be required to pay for office visits, even when they result in medical marijuana certification for the patient. Any attempts to deny coverage for medical services just because medical marijuana is discussed will be deemed unlawful under New York State Insurance Law.
Insurers do not have to cover the actual medical marijuana when it is obtained from the dispensary, however.
There is still one caveat to this insurance coverage of marijuana-related medical appointments. Getting certified for medical marijuana use cannot be the sole purpose of the visit. Patients in New York need a doctor to certify they suffer from one of the approved conditions and meet other criteria before they can get their marijuana card.
If a patient schedules a doctor’s appointment for the sole purpose of gaining medical marijuana certification, the insurance company can deny coverage for that visit in New York. A medical appointment with a different objective or that includes other medical services not related to medical marijuana, however, must be covered. The medical marijuana certification can be a result of such an appointment and not affect insurance coverage.
Impact on New York Patients
Disallowing health insurance companies from denying coverage when medical marijuana is mentioned is at least a small step forward for New Yorkers. Cost can be the biggest barrier for access to medical marijuana. Since the process in New York requires a doctor’s visit, the out-of-pocket cost for a visit keeps some patients from even qualifying for medical marijuana.
Doctors are reluctant to mention medical marijuana as an option if they know the conversation could void health insurance coverage. By holding back this option for patients, doctors are forced to ignore medical facts and not do everything possible for their patient’s well-being. Patients suffer when they do not have access to all the options for controlling their conditions.
Future of Medical Marijuana in New York
It is a good sign for medical marijuana in New York that the state is bringing insurance companies into the conversation. The federal law banning marijuana for any purpose conflicts with newer medical research and state laws in many parts of the country. Doctors do not write prescriptions for marijuana for that reason. They only make recommendations for medical marijuana patients.
Insurance companies do not pay for medical marijuana as part of the prescription coverage they offer for the same reason, leaving patients with big out-of-pocket costs for a treatment that can be their last hope and the only thing that works for them. The next step in a comprehensive medical marijuana program would be to address the cost issue.
New York’s willingness to come up to the line with insurers and hold them accountable for coverage of office visits bodes well for future changes to medical marijuana regulations in the state. It could be a race now to see what changes first, the FDA’s classification of marijuana as a Schedule I drug or New York’s requiring insurers that do business in the state to fully cover medical marijuana.
In many cases, marijuana could be a less expensive alternative for treatment that might prevent more costly health issues. Marijuana can treat pain in place of opiates that are highly addictive and damaging to physical health. It can also help manage seizures, so patients can live independently and maintain regular employment. Insurance companies could end up saving a lot of money by covering cannabis treatments.
To take advantage of this new development in New York medical cannabis insurance coverage, start by searching for a marijuana doctor in New York to get certified as a medical marijuana patient. Follow our blog for updates as the New York continues to evolve its medical marijuana program.