An Ontario university student may have just established a precedent that could pave the way for coverage of medical marijuana by private insurance plans in Canada.
Jonathan Zaid, 22, says cannabis is the only thing that helps him concentrate long enough to get through his studies at the University of Waterloo. Zaid can legally access the drug since he has a doctor’s authorization, but he said he couldn’t afford the $30 a day the drug cost.
“I’m a student, I have no income really so at the end of the day it was my parents paying for it and I felt really bad asking my parents to pay for my medical marijuana.”
Zaid spoke to his school about his situation, and the health insurance provider for University of Waterloo students, Sun Life, ultimately decided to cover the drug for Zaid.
Cannabis is a legal treatment for patients with a doctor’s authorization in Canada. However, Health Canada and the medical community do not recognize it as a valid form of treatment because it hasn’t been subjected to the intensive research trials that pharmaceuticals undergo. And marijuana doesn’t have a Drug Identification Number (DIN), which is the industry standard usually required before a pharmaceutical is authorized for sale and reimbursement.
The lack of a DIN is a sticking point for doctors, many of whom are reluctant to sign medical documents for patients who make a case for medical marijuana.
At 14, Zaid was diagnosed with a chronic condition known as New Daily Persistent Headache, a severe recurring migraine-like pain that disrupts sleep and causes sensitivity to light and noise.
Soon after his condition developed, he dropped out of grade eight and did short stints at public high schools until he could find a private school that could cater to his needs.
He has tried 48 different pharmaceuticals to manage the 24/7 pain. At 16, he learned about marijuana as a potential treatment and approached doctors for help, but they were dismissive.
“They said medical marijuana is off-label but at the same time, I had already tried 40 prescription medications that were not indicated for my condition so their arguments were not the strongest,” he said. “But they were physicians and they were the experts.”
He ending up trying marijuana on his 18th birthday.
“My mom gave me a joint because she couldn’t stand to see me in pain any more.”
Since then it has been difficult for him to get a legal supply.
He bought pot from dealers, but sometimes the strains he got worked and sometimes they didn’t.
“It was always very hit or miss, there was no level of consistency or standardization there so it wasn't really working out.”
Then last year, he found a doctor willing to write a “medical document” (doctors refuse to call it a prescription because the drug doesn’t have a DIN) for Zaid to gain legal access to marijuana.
The doctor charged $300 to sign the document that was valid for one year, telling Zaid he’d be able to help him figure out dosages over time. Zaid has since been reimbursed by the Ontario Ministry of Health for the document, after a ruling that doctors cannot charge for them, similar to prescriptions. The College of Physicians and Surgeons of Ontario has just ratified a policy disallowing doctors from charging fees.
Shortly after Zaid got his authorization, the doctor left the country to attend to a family issue and he was left to figure out the system on his own. Strains were hit-or-miss and the cost of trying out strains that didn’t work added up. The licensed producer he signed up with had product only sporadically. He has since found a new doctor willing to vouch for him and a new licensed producer with enough of his preferred product in stock.
At the same time, Zaid began to petition the university for coverage of medical marijuana under their student health care plan. He first submitted a claim in June, which was refused because his drug had no DIN.
But Zaid didn’t believe that was a valid reason for refusal. Just a few months prior he had successfully submitted a claim using the “restricted drug use” form, meant to cover alternative pharmaceuticals when the usual drugs prove ineffective. He had used it to get a sleep medication only available in the U.S., which did not have a DIN in Canada.
He met with an oversight committee at the school that included a doctor, representatives from the student unions and from the university’s health services department to argue for coverage. He came armed with information from his latest licensed producer, a company called Bedrocan, as well as a sleep study suggesting medical marijuana was an effective treatment for his condition. He also brought a list of the 48 pharmaceuticals he had already tried, as well as the note from his doctor.
After evaluating the medical evidence, the financial impact on the plan and the impact the coverage would have on Zaid’s academic success and wellbeing, the committee approved Zaid’s request for coverage, the students’ union said in a statement.
Zaid submitted his first claim for medical marijuana, as well as a vaporizer — a device used as an alternative to smoking — in December. In the few months since, he has been reimbursed more than $2,000.
“Managing a chronic debilitating condition is not an inexpensive thing to do, pharmaceutically at least,” he said.
“At the same time from the insurance company’s perspective, it actually saved money because my sleep medication from the U.S. was $15 a day, my pain medication was $10 a day [and] my mood medication was $20 a day.”
Sun Life said it could not comment on the specifics of the case, but issued a statement Monday.
“Currently medical marijuana is not considered an eligible benefit in our standard drugs plans. We do consider, and where possible, accommodate requests for exceptions if directed by the plan sponsors," the insurer said.
Canada’s medical marijuana industry is lobbying for government health plans and private insurers to cover medical marijuana like other treatments, It would potentially mean a boom in business for providers.
However, insurers are largely reluctant to open those floodgates.
The cost of medical marijuana is also at the heart of an ongoing legal battle between patients and the federal government. Up until last year, approved medical marijuana patients were allowed to grow their own supply.
But Health Canada is pushing to ban the practice, and wants all patients to buy solely from commercial producers. Health Canada says too many home grow operations are unsafe, while patients say the $5 to $12 per gram charged by the large-scale producers is unaffordable. The trial is expected to wrap up later this month.
Zaid has started an organization, Canadians For Fair Access To Medical Marijuana to push for more insurers to cover medical pot.
“Now we know Sun Life can cover it if the employer wants it but employers will only want it if workers argue for it,” he said adding that Sun Life now has a system in place to process such claims.
“I hope to help advocate for patients on a national scale by promoting medical marijuana so that physicians and everyone becomes more comfortable with it and to decrease the stigma of it.”
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