Canadian HR Reporter

CANADIAN HR REPORTER September 7, 2015 12 NEWS Are you looking to reach occupational health and safety professionals across the country? Get your listing in the Health and Safety section of HR Vendors Guide online and in print. Visit www.hrreporter.com/hr-vendors-guide to enter your firm's information. Visit www.hrreporter.com/hr-vendors-guide HR VENDORS GUIDE HR VENDORS GUIDE Attention OHS vendors and suppliers cost of it, they didn't see that it would be a huge cost… it's not that expensive in the context of pharmaceuticals." As things stand, insurance cov- erage for medical marijuana is a rarity in Canada — Zaid's own case with Sun Life and Meda- vie Blue Cross are the only two plans that are publicly known to be paying for medical cannabis, he said. Medical marijuana is consid- ered to be a controlled substance and, as a result, it cannot be cov- ered under regular supplementary health benefit plans, said Wendy Hope, vice-president of external relations at the Canadian Life and Health Insurance Association in Ottawa. In rare circumstances, it may be covered on an exception basis at the request of a plan sponsor, as long as the plan can accommo- date it. But that might be about to change, according to Khurram Malik, co-head of research for in- vestment bank Jacob Securities in Toronto. "I think in (the near future) you'll see some of the smaller in- surance companies or the more niche-y ones covering it, and then you'll see the larger ones," he said. Obstacles to acceptance To qualify for insurance cover- age, medical marijuana would need a drug identification num- ber (DIN), said Hope, which it currently does not have. "Like any new drug, medi- cal marijuana would have to go through Health Canada's assess- ment process before it could enter the marketplace as a prescription drug with a drug identification number (DIN). Only then can in- surers consider providing cover- age under its regular plans." Stigma and misconceptions around medical marijuana are another hurdle, said Cam Battley, vice-president of communica- tions and corporate development at Bedrocan in Toronto, a produc- er of medical cannabis. at's why many in the industry use the term "medical cannabis." "We call it medical cannabis and that's a very important dis- tinction because… what we do is very, very distinct from the per- ceptions… and the stigmas asso- ciated with street marijuana," he said. ere certainly are still over- tones of prohibition and illegiti- macy, said Bruce Linton, chair- man and co-founder of Tweed Marijuana in Smith Falls, Ont. "(But) those go away more and more every day as we see indica- tions of benefits across multiple user groups," he said. e biggest obstacle Zaid sees, whether for insurers, HR or regu- lators, is education. "People have so many pre-con- ceived notions on marijuana and weed, and they don't really un- derstand medical cannabis. ey don't understand the use and they don't understand the nuances," he said. "People aren't going to work and (getting) high— they want to take the medicine to improve their quality of life… and they un- derstand they can't work properly when they're intoxicated." Employers need to understand that medical cannabis patients are not using this product recreation- ally, said Battley. "According to Health Canada statistics, the average patient is using approximately one gram of medical cannabis per day… that's not sufficient for patients to get high, that is sufficient for patients to manage their chronic pain or manage the symptoms of an anxiety disorder," he said. "So people are using this product responsibly." It may also ease the sense of legitimacy when medical canna- bis is offered in a pill form, said Malik. "That makes it considerably more appealing to doctors and considerably more appealing to the casual patient who maybe is not comfortable with marijuana in the traditional ways that you consume marijuana. It's popping a pill rather than smoking it — it's more convenient and it (reduces) the psychological stigma." Floodgates firmly closed However, there are other dimen- sions to consider, including the public relations side of the coin, said Zaid. "When the university consid- ered (my) case, which took eight months and lots of deliberation and consideration, they looked at three main things. ey looked at the economics… they looked at the impact on my academics," he said. "(And) they looked at the PR- side of things — what would it mean if they covered medical cannabis under an insurance plan? Would it open the flood- gates and tons of students would try to access medical cannabis for recreational or non-medical purposes?" For Zaid, the answer is no. "People understand that medi- cal cannabis is a medical treat- ment now, and part of that is that regulations are made so that it is difficult to access. Even people with an established medical need have difficulty accessing medical cannabis. So if you have no medi- cal need and you have no docu- mentation, it's very challenging (to access)," he said. "So we're not seeing the flood- gates open." Nobody is recommending medical cannabis as first-line therapy, said Battley. "e patients that we have (at Bedrocan) typically have tried other therapies so they have been refractory to standard prescrip- tion regimens — or they have experienced such side effects that they were intolerable to the patient. So people do not tend to go for medical cannabis first; they tend to go for medical can- nabis when other regimens have failed." Cost, risk benefits to medical cannabis Some of the strongest arguments for insurance coverage of medi- cal cannabis compare the costs and risks of cannabis versus other medical treatments, said Battley. "There are some examples, like Jonathan's, where there are clear economic offsets. e cost of medical cannabis is actually less than the cost of the previous regimen that medical cannabis is replacing," he said. In this way, it's a profit motive for insurers and plan sponsors, said Malik. "It's cheaper for them to insure marijuana than it is to insure your typical, traditional medicines for certain maladies," he said. "It's cheaper to insure than it is to insure opioids such as OxyContin." ere are also factors of efficacy and liability, said Linton. "e compelling reason for an insurer is… something that has less liability, equal or better effi- cacy and a lower cost base prob- ably is a winner," he said. "So, on that basis, I do believe it will happen. "If you have a choice of tak- ing something that requires you to have a frequent liver function test or results in you having the inability to reliably turn up at work… or having something that doesn't have those negative side- effects, the patient (will) demand that." Advocates for medical cannabis often compare it to other catego- ries of medicine, said Battley. "One very good example is opioids. Canada has a real opioid problem — we have the second- highest per-capita use of opioids in the world. And opioids come with a lot of problems," he said. "The first is the side-effects. Patients using opioids have real difficulties with nausea, with con- stipation, with mental confusion, and there's that ever-present risk of addiction. Medical cannabis, when used by patients to man- age a chronic pain condition, is typically used as an alternative to opioids." Competitiveness factor? If plan sponsors start pushing to offer medical cannabis coverage, it probably won't be long before others follow suit in a bid to stay competitive, said Malik. "It's a very cut-throat, competi- tive industry… it just takes one or two to be aggressively out there," he said. And if plan sponsors want it, insurers will do what they can to acquiesce, said Zaid. "From my experience, the in- surer probably matters the least out of any of the parties at hand. It really comes down to the em- ployer and their willingness and incentive to put it onto the formulary. When we're talking about large-scale employers — 100-plus employees — that big of a client is too important to an insurer to lose over a claim on medical cannabis." Coverage will likely remain an exception in the beginning, said Battley. "However, I think as this evolves, it will be added as a stan- dard benefit because there are wins in this for appropriate pa- tients," he said. And the bottom-line benefit for employers? e ability to have productive, talented workers who may otherwise be suffering from debilitating symptoms, said Linton. "We have a number of people who are legitimate patients who, without this medicine, may or may not be employed. And with it are fantastic, productive, cre- ative people in our organization — and many of them are core leaders." Cost of marijuana can be less than other regimens MEDICAL < pg. 1 "e insurer probably matters the least out of any of the parties. It really comes down to the employer and its willingness and incentive to put it onto the formulary."

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