How Medical Marijuana Saved Medicare Part D Millions

Pharmacist and customer with medical marijuana
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Whether or not you believe cannabis should be used in healthcare, the fact remains that medical marijuana is permitted in 34 states and the District of Columbia. Eleven states (Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington) and the District of Columbia even 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 that 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 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.

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 of the drug. In August 2016, the DEA declined those petitions, keeping marijuana as a Schedule I drug.

Is Marijuana More Dangerous Than Cocaine?

You would be hard-pressed to find someone who doesn't think that cocaine is a dangerous, addictive drug. Interestingly, however, cocaine is a Schedule II drug. That means the federal government currently sees medical benefits from cocaine but not marijuana.

Cocaine has been used predominantly as a topical anesthetic for ear, nose, and throat conditions and even as a vasoconstrictor to help stop nose bleeds. Its use is limited to application by medical professionals. What can marijuana be used for? The government states there is not enough information to prove that it is safe.

Federal regulations that pose limitations on research are tricky. First, research requires money, and grants are harder and harder to come by given the nature of a drug deemed dangerous and addictive by Schedule I standards. To proceed with research, an application has to be made to the Department of Health and Human Services to access research-grade marijuana; marijuana that comes from the one farm in the United States that has been federally approved to grow it, a farm at the University of Mississippi. Only in August 2016 did the DEA state that it would allow other universities to apply to grow marijuana for research purposes.

Then researchers have to get permission from the DEA to possess and transport the drug. Years may elapse before a study can even get off the ground, if at all. The end result is that there are not many clinical trials to support its use, at least not enough to convince the federal government. Not yet.

Medical Marijuana Uses

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

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

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 are a concern.

The Food and Drug Administration currently approves three cannabinoid medications for use in the United States. Cesamet (nabilone) and Marinol (dronabinol) are used to treat nausea and vomiting in people taking chemotherapy. Marinol may also be used to treat anorexia and weight loss in people with HIV. These medications are Schedule II and III, respectively, despite being synthetic derivatives of THC. 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. The DEA has listed this medication as Schedule V.

Medicare and Medical Marijuana

Medicare will not pay for Schedule I drugs because by definition they are not medically necessary. Not only that, but Medicare is a federal program and in the eyes of the DEA, a federal agency, marijuana is against the law. Unless the DEA makes a schedule change (and it refused to do so in August 2016), 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 hasn't stopped people from using it.

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 beneficiaries that 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 three FDA-approved medications, remain on 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 (CMS) see medical marijuana as an option to cut costs and to decrease opioid overuse in the future? Time will tell.

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