Cannabis in health plans is a response to growing medical evidence, says provider
This summer, Canada will become the first western nation to legalize cannabis. It’s a historic move, although the drug has been available for medicinal purposes in this country since 2001. Despite that, insurers have been very cautious when it comes to cannabis coverage, with only isolated cases taken under consideration.
That all changed last week when Sun Life Financial announced it would add medical cannabis to its group benefits plans as of March 1. There are a number of conditions attached of course, but it constitutes a significant step forward for advocates of the drug in Canada.
For years, cannabis’ lack of a drug identification number (DIN) issued by Health Canada was a sticking point for providers. Dave Jones, SVP, Group Benefits at Sun Life explains how the firm eventually got past that obstacle.
“We are doing this under a process called prior authorisation, so that allows us to receive an application from a plan member that includes their physician’s authorization and proves that cannabis has been dispensed from a Government of Canada approved dispensary. We adjudicate the claim that way so we don’t need a drug identification number.”
Sun Life has also limited coverage to five conditions – cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS or patients requiring palliative care. There is growing medical evidence that those illnesses and associated symptoms can be alleviated using medicinal cannabis, which is why Sun Life saw fit to change tack at this point.
“It’s something we have been considering for some time,” says Jones. “Our clients have been looking more and more at medical cannabis. Client demand is driving us to offer it as an option outside of the HAS (health spending account) so that plans can increase coverage for the medical conditions that are covered.”
Coverage for the drug ranges from $1,000 to $6,000 per plan member, but Jones doesn’t foresee that having a major impact on premiums for plan sponsors. While the cost of cannabis prescriptions will be added to plans, it will likely mean less use of other, usually more expensive, drugs, he explains.
“For plans that decide to have the coverage, they will see an increase in usage only with plan members that have one of those five disease states,” says Jones. “They may also see a decrease in other drugs and forms of therapy as plan members work with their treating physicians to manage their pain and care. It will probably take a number of months to a couple of years to really know what the impact is, but we expect it to be minimal.”
Forgetting cost for a moment, Jones explains that this decision was made in good faith to help people that are suffering. Sun Life has been offering cannabis coverage through healthcare spending accounts on a limited basis for a number of years now, so this latest move simply builds on that position.
“When we step back and look at our purpose as an organisation, we see our role as helping our clients to live a healthier life – it’s not a tagline, we are true to that,” he says. “In this case, you have medical evidence that shows that for each of these illnesses and the associated symptoms, the health benefit to people outweighs the risk. We have an opportunity here to help Canadians get the treatment they need to manage their medical conditions. It’s something we are only too happy to do.”
