NY insurers not planning to cover medical marijuana
ALBANY — With about four months left before the state’s medical marijuana program is slated to become fully operational, many insurers have no plans to cover the Schedule I drug under their current policies.
Excellus BlueCross Blue Shield, one of Western New York’s largest insurers, only covers drugs approved by the Food and Drug Administration under its current policy, a spokesman told POLITICO New York.
An Aetna spokesman echoed the sentiment, adding that the insurance company already covers Marinol, an FDA-approved drug that contains some of the same elements as marijuana and is used to treat nausea.
Emblem Health, one of the state’s largest insurance providers, also has no plans to cover medical marijuana. Medicaid will not cover it either.
In late July, the state health department announced the five applicants that would be awarded two-year licenses to manufacture and distribute medical marijuana in New York to a very limited group of people with serious illnesses.
Unlike laws in other states, the law passed by the Legislature and signed by Gov. Andrew Cuomo in July 2014 requires that the state’s health department — not manufacturers — set the price for the drug, leaving patients trying to access it uncertain about its affordability.
The health department did not respond to questions about pricing.
Julie Netherland, the deputy state director of the Drug Policy Alliance, a group that has been pushing for medical marijuana, said that cost has been a concern for patients.
“It has been a major concern for patients and families,” she said. “Some patients are going to simply be left behind because they’re not going to be able to afford the medicine.”
She said the group reached out the health department before the regulations were released, unsuccessfully encouraging the agency to create some sort of incentive so licensees would create a program for low-income patients to gain access. Netherland said a request by advocates and patients that a portion of the tax revenue from the medical marijuana be set aside to create a charity pool had also failed. But nowhere in the law, she said, does it say that the manufacturers can’t set up their own charity program.
"The good news is that there is nothing to stop the producers from setting up some kind of sliding fee scale or charity program for low-income patients. And I'm hopeful," she said.
Meanwhile, other insurers have not yet decided how coverage will be determined.
Deborah Fasser, a spokeswoman for the New York State Conference of Blue Cross and Blue Shield Plans, said coverage for patients who fit the requirement to be administered medical marijuana will be based on conventional medical management.
"New York State has passed the law, which is only now being operationalized,” she said in an email to POLITICO New York. “The law does not include an insurance mandate and coverage will based on conventional medical management and benefit determinations.”
And since it’s still a federal crime to grow, possess and distribute marijuana, MVP Health Care, a Schenectady-based insurer, is taking a wait-and-see approach.
“At this time, medical marijuana is not covered by MVP Health Care. As state and federal law concerning medical marijuana evolves we will continue to review our policies to ensure they are in keeping with our commitment to provide our members access to the most efficacious and appropriate medical care,” said spokeswoman Jo Ann LeSage Nelson.
--additional reporting by Dan Goldberg