Canadian HR Reporter Weekly

3 Canadian HR Reporter, a Thomson Reuters business 2018 July 25, 2018 e firm is particularly interested in covering marijuana when it might be more effective than addictive pharmaceuticals such as opioids, said Brad Fedorchuk, senior vice-president at Great-West. Marijuana's often higher costs make it that much more important for insurers to scrutinize the conditions they cover, said Mike Sullivan, CEO of insurance analytics firm Cubic Health in Toronto. For instance, Baclofen, a muscle relaxer also used to treat spasticity, costs $28.82 for a 10-day supply. Health Canada has estimated the average daily dose of marijuana, also used for spasticity, at between 0.68 grams and 1.5 grams, with a gram costing about $8. "If you open the door to conditions like post- traumatic stress disorder, short-term sleep disturbances... you start encompassing a lot more people," said Sullivan. Surging costs Veterans Affairs Canada began covering up to 10 grams per day of medical cannabis for its members in 2008, with no limits on price or medical condition. After costs surged to $63.7 million in the year ending March 2017 from $19,088 in fiscal 2009, the group limited coverage to three grams a day at $8.50 a gram. Total reimbursements fell to $51 million in the year ending March 2018. e agency imposed limits to give patients a more appropriate dose, said Courchesne, but also considered costs. Christine Gopner-Reinecke, a spokesperson for Germany's AOK Bundesverband — the largest of the groups administering the nation's public health insurance — cited many of the same concerns on cost and usage. As of May, AOK had approved 9,700 patients for medical marijuana — about two-thirds of its applications since Germany legalized medical marijuana last March. "We just cover it because the government wants us to," said Gopner-Reinecke. "We wouldn't cover it if it was up to us." e Canadian Medical Association has warned members to proceed with caution, citing a lack of evidence supporting cannabis treatment. Jeff Blackmer, the organization's vice-president for medical professionalism, said he authorized medical marijuana for two of his patients when all other treatments had failed, but had seen little improvement. Research is also inconclusive on whether marijuana effectively reduces pharmaceutical drug use when both are incorporated into treatment, said Courchesne. Some studies, including one conducted at the University of New Mexico, have found that legal access to cannabis may reduce pharmaceutical drug use in certain patient populations; but other studies, including one published in the Journal of Addiction Medicine, concluded that marijuana use increases the risk of prescription drug abuse. Prescriptions and fees Another problem, said Courchesne, are doctors and or- ganizations that prescribe marijuana with little scrutiny of patients' medical need, often advertising themselves as a source of pot prescriptions. Doctors' visits and prescriptions for any drug are generally free to patients in Canada, covered by provincial governments. But groups such as OneOunce.com and the Green Doctor Network directly charge patients fees ranging from $150 to $295 for consultations leading to marijuana prescriptions. e Green Doctor Network requires no documentation or referral, other than an online application form. (e organization did not respond to requests for comment.) OneOunce.com offers both in-person and Skype consultations, and requires a diagnosis or referral from a family doctor or specialist who has prescribed pharmaceutical drugs, said Fiona Fry, who handles patient services. e company charges fees, she said, because it uses private physicians who don't bill governments and they spend more than the usual 15 minutes with patients. e Federation of Medical Regulatory Authorities of Canada expects physicians to authorize marijuana only for patients with whom they have an existing medical relationship and after in-person consultations, said CEO Fleur-Ange Lefebvre in a statement. National Access Cannabis contacts patients' doctors for their medical history before writing pot prescriptions, said Evan Loster, a senior manager. e service is needed, he said, because many traditional doctors won't prescribe marijuana. "Many physicians don't feel professionally comfortable recommending a treatment they don't know enough about," he said. Many physicians don't feel comfortable recommending a treatment they don't know enough about." Credit: Lifestyle discover (Shutterstock) While some studies have found legal access to cannabis can reduce pharmaceutical drug use in certain patient populations, other studies have concluded marijuana use increases the risk of prescription drug abuse.

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