Medicare and Marijuana: What Is and Is Not Covered

Whether or not you believe cannabis should be used in health care, medical marijuana is permitted in 33 states and the District of Columbia. Twelve states (Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington) and the District of Columbia also allow recreational use of the drug.

The federal government does not agree. The U.S. Drug Enforcement Administration (DEA) continues to categorize marijuana as a Schedule I drug—and that makes it illegal. What does this mean for people on Medicare who may want to use the drug for treatment?

Understanding the Controlled Substances Act

The Controlled Substances Act (CSA) of 1970 devised a system for classifying drugs. It divided drugs into the following five categories, or schedules, based on their risk for triggering substance abuse or dependence.

• Schedule I: No accepted medical use; high risk for abuse and dependence
• Schedule II: Accepted medical use; high risk for abuse and dependence
• Schedule III: Accepted medical use; moderate to low risk for abuse or dependence
• Schedule IV: Accepted medical use; low risk for abuse or dependence
• Schedule V: Accepted medical use; lowest risk for abuse or dependence

Though the words are often used interchangeably, abuse and dependence are quite different. In simplest terms, dependence means the body physically needs a drug, whereas abuse means someone's mind, their emotional or psychological state, needs it too.

With legalization in multiple states, petitions have been made to the DEA to recategorize marijuana from a Schedule I to a Schedule II drug. This would have ramifications that would not only affect local law enforcement but also regulations about production and even importing and exporting the drug. In August 2016, the DEA declined those petitions, keeping marijuana as a Schedule I drug.

Medical Marijuana Uses

There are, however, studies that support marijuana's clinical use. Research shows the health benefits of marijuana and its derivatives, especially the active component of marijuana known as tetrahydrocannabinol (THC). More data, however, is available in animals than humans.

Conditions that have data to support the use of medical marijuana, at least to some extent, include:

• Appetite suppression
• Cancer-related pain
• Epilepsy
• Glaucoma
• HIV
• Multiple sclerosis
• Nausea and vomiting
• Peripheral neuropathy
• Alzheimer's disease
• Crohn's disease

There is less support for the use of medical marijuana in fibromyalgia, Huntington's disease, Parkinson's disease, rheumatoid arthritis, or non-cancer-related pain. In all cases, psychoactive side effects remain a concern.

Medications Derived From Marijuana

In order for Medicare to cover a medication, it must be approved by the Food and Drug Administration (FDA). This means a medication has undergone clinical trials and shown benefits for treating specific medical conditions. As of October 2020, the FDA currently approves only four medications derived from cannabinoids for use in the United States:

• Cesamet (nabilone) is a synthetic derivative of THC. This oral medication is used to treat nausea and vomiting in people on chemotherapy. It is a Schedule II medication.
• Epidiolex (cannabidiol) was approved by the FDA in June 2018 to treat two rare types of childhood-onset epilepsy known as Dravet syndrome and Lennox-Gastaut syndrome. In 2020, the FDA also approved it for treatment of seizures secondary to tuberous sclerosis complex in patients at least 1 year old. The DEA has listed this medication as Schedule V.
• Marinol (dronabinol), like Cesamet, is a THC derivative and is used to treat chemotherapy-induced nausea and vomiting. However, it also has a second indication. This Schedule III medication can also be used to treat anorexia and weight loss in people with HIV.
• Syndros is another formulation of dronabinol and has the same indications as Marinol. The difference is that it comes as an oral liquid rather than as a capsule. Interestingly, it is categorized as Schedule II, rather than Schedule III.

Some Medicare Part D prescription drug plans or Medicare Advantage plans with Part D coverage may cover these medications. Check to see if they are on your plan's formulary.

Medicare and Marijuana

Medicare, a federal program, will not pay for Schedule I drugs because the DEA, a federal agency, states marijuana is against the law. Until the DEA makes a schedule change, medical marijuana is off the table for Medicare beneficiaries unless they specifically use one of the FDA-approved medications. Any other type of marijuana treatment will need to be paid for out of pocket.

That doesn't mean you are unable to use medical marijuana as a Medicare beneficiary. A healthcare provider cannot prescribe or order it you per se, but they can make a "recommendation" or "certification" for it.

Each state has its own rules and regulations regarding medical marijuana. Many states require practitioners to register with their medical marijuana program.

These practitioners need to be in good standing, have an active medical license, establish a patient-healthcare provider relationship with you, educate you about the pros and cons of different routes of administration, and document a care plan, including treatment goals and expectations. Depending on the state, they may only be able to recommend medical marijuana for certain medical conditions.

You will need to actively seek out medical professionals involved in those programs, but your medical professional may already be registered. If you live in a state where recreational marijuana is legal, there may be fewer hoops to jump through.

Once you have a recommendation or certification in hand, you will then be able to go to a state-approved medical marijuana dispensary. Unfortunately, as mentioned, you will have to pay out of pocket.

How Medical Marijuana Helps Medicare

Medicare may not pay for medical marijuana, but medical marijuana has had an impact on Medicare.

According to a 2016 study in Health Affairs, spending on Part D medications decreased in states where medical marijuana was accessible. The implication is that people turned to medical marijuana instead. Specifically, Part D medications were prescribed less for conditions that could be treated alternatively with medical marijuana.

The savings to Medicare amounted to $165 million in 2013. Researchers estimated that those savings could have been as high as $470 million if medical marijuana were legal across the country.

Not only did medical marijuana decrease Medicare Part D spending, but it also decreased daily opioid use. A 2018 study in JAMA Internal Medicine found a significant decrease in daily hydrocodone and morphine use for Medicare Part D beneficiaries who lived in states with medical marijuana laws.

Specifically, from 2010 to 2015, hydrocodone use decreased by more than 2.3 million daily doses (17.4%) and morphine use decreased by nearly 0.4 million daily doses (20.7%) in states that had medical marijuana dispensaries.

Looked at in this way, medical marijuana could decrease the burden of the opioid epidemic in a way that the current Medicare opioid guidelines have not.

A Word From Verywell

The FDA and DEA continue to butt heads over the medical benefits of marijuana. At the present time, marijuana and its related products, with the exception of four FDA-approved medications, remain classified as Schedule I.

Despite that, studies have shown that Medicare Part D beneficiaries living in states that have legalized medical marijuana have saved millions of dollars on prescription medications and have significantly decreased the use of opioid medications.

Will the Centers for Medicare and Medicaid Services see medical marijuana as an option to cut costs and decrease opioid overuse in the future? Time will tell.