Regulation of Medical Marijuana
- Medical marijuana has been legal in Canada for approximately 15 years - 40,000 authorized users.
- Regulation of distribution and use similar to regulation of other prescription drugs.
- Medical marijuana generally not covered by group drug benefit plans.
- Group insurance plans only cover drugs which have a drug identification number.
- Health Canada refuses to issue a drug identification number for medical marijuana.
Regulation of Medical Marijuana (cont.)
The Corporation of the City of Hamilton and Hamilton Professional Firefighters Association (Ont. Lrb. Arb.)
- First decision on whether worker entitled to reimbursement for medical marijuana under group health plan.
- Grievor claimed reimbursement from benefit plan for medical marijuana use by spouse.
- Spouse had medical authorization for use of medical marijuana.
Regulation of Medical Marijuana (cont.)
- Relevant provisions in the collective agreement:
- The employer shall pay the full cost of the premiums of the Canada Life extended medical plan, including semiprivate coverage and drugs, for all employees...
- Drug claims must indicate the prescription number, name, strength and quantity of the drug plus the drug identification number.
- Drugs – Formulary 2 mandatory generic plan: drugs, serums, injectables and insulin (needles, syringes and test tapes for use by diabetics) purchased on the prescription of a medical doctor.
Arbitrator's Decision
- No coverage
- Medical authorization similar to a prescription but is not a Prescription
- "Purchased on the prescription of a medical doctor"
- Most important factor: the union and the employer specifically agreed that the drug benefit plan would only reimburse employees for drugs which have a drug identification number
Lessons From City Of Hamilton
- Decision provides reassurance that arbitrators will not necessarily read-in medical marijuana coverage into group health plans
- But collective agreement language unusual
- Some collective agreements include broad enough language to include medical marijuana in coverage
- Employers should review their collective agreements and related documents carefully
Trends in Coverage
- Some providers are covering medical marijuana if employer or plan sponsor expressly asks provider to cover
- University of Waterloo – Sun Life agreed to cover medical marijuana for student covered under student plan - student union advocated for coverage because of specific medical condition
- Some providers may also allow coverage through health spending accounts
- Is considered an eligible "medical expense" for purposes of CRA
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.