This is the fixth in a multi-part series on the effects of the ongoing legalization of marijuana in the worker’s compensation insurance ecosystem. In case you missed them here’s part one, part two, part three, part four & part five. This series is being ran in preparation for a panel on “Legalization of Marijuana and the Impaired Workforce” that the author is moderating at the AmComp Fall Conference in NYC on November 8, 2018. Opinions expressed are those of the author and are not necessarily held by the author’s employer or AmComp. Insurance Nerds readers can save $100 on registering for AmComp with discount code AMCOMPNERDS.
The compensability of medical marijuana in workers’ compensation continues to be debated and litigated. While marijuana is medically legal in a majority of states, not many have “gone all in” to assimilate the benefits of the state’s medical marijuana program and workers’ compensation benefits. I have previously discussed foundational issues with the system including marijuana prescriptions that, instead of being tailored to specific diagnoses, are an open invitation to an all-you-can-eat-buffet. Overcoming this hurdle should allow marijuana to be treated similarly to other classes of drugs. Potentially, the next step may be to integrate medical marijuana into a state’s existing drug formulary.
If a treating physician prescribes Oxycodone, he or she can easily select the dosage and quantity. Marijuana, as a medication, is not prescribed in a similar manner; rather, decisions on potency and usage are left up to the patient’s personal discretion. Cannabis is a broad product and it has almost limitless dosage combinations based upon strains (crossbreeding has led to numerous hybrids) with a full spectrum of THC concentrations. Marijuana can have a THC level of 1% to 90% with increments as small as a single percentage point. Different strains are recommended for different ailments, though it is more anecdotal, not scientific. To further compound the issue, the drug comes in a variety of forms: flower, oil, sprays, and gelatins. States that decide to incorporate it into their drug formulary have an immense task ahead of them, but a potentially worthwhile endeavor if they choose.
The drug formularies states have already implemented provide safe and effective prescribing guidelines for both providers and payers. Any introduction of marijuana into the formulary will need to be consistent with the state’s own treatment guidelines and appropriately define the use of marijuana, not only as a stand-alone medication, but as also when it is used in conjunction with other medications that may be prescribed to the patient. While the lack of research and evidence-based medicine are an impediment to development, states should begin to review, and work with medical experts, to advance the process.
A major concern is that unlike traditional prescriptions, which all contain a National Drug Code (NDC), marijuana does not. NDC numbers ensure patients are getting strength and dosage per their physicians’ order. Without standardization, the repercussion between want is prescribed, and what is ultimately consumed, can be severe. Unless changes are made at the federal level, it would be a states’ responsibility to develop a mechanism for controlling and tracking prescriptions. Many states with legal medical marijuana are already putting “seed-to-sale” monitoring protocols into action, and building off of this framework to include a final step on the consumer end may be the easiest route.
In conclusion, drug formularies have shown significant benefits in the states where they have been adopted. They have reduced unnecessary prescriptions, helped to limit opioids, and reduce overall costs. A detailed framework for marijuana will mitigate future disputes and help control costs in states where the treatment benefit is offered; however, the success of the formulary is predicated on stakeholder buy-in, the establishment of clear guidelines, and better education for prescribing physicians.
Brian Reardon is a Board Member of AmComp and AVP, WC Claims for Maiden Reinsurance. He will be moderating the upcoming panel session on “Legalization of Marijuana and the Impaired Workforce” at the AmComp Fall Conference in NYC on November 8, 2018. Opinions expressed are those of the author and are not necessarily held by the author’s employer or AmComp.