Canadian HR Reporter

CANADIAN HR REPORTER APRIL 2018 16 NEWS "I think that in 2018, you're go- ing to see many more organiza- tions publicly announcing their coverage, and it will still be a relatively small percentage," said Fleming. "Five years from now, it will be quite common. The ground is shifting quickly." Medical marijuana has a higher cannabidiol (CBD) content than recreational marijuana, disassoci- ating it with the euphoric high that recreational users feel as a result of tetrahydrocannabinol (THC). e way medical marijuana is currently being off ered, only pa- tients with specifi c ailments will have access to the drug, said an. "What we've observed from the trends of the industry is that when- ever this is going to be covered, it tends to be very, very specific, meaning that it would be under prior authorization, so the patient would have to submit medical in- formation to justify the use of that substance," she said. "It would have to be for very specifi c indications." Plan sponsors looking to add the benefi t should ensure that all verifi cations and approved guide- lines are included within the pol- icy, in terms of approved indica- tions, caps, and regular revision of limitations, said an. To qualify for Sun Life coverage, for instance, plan users will need to meet conditions listed, said Jones, and medical marijuana will be available to people struggling with cancer, multiple sclerosis and rheumatoid arthritis, or requiring palliative care. "What we're really looking for is to make sure it has been pre- scribed by a physician and it's being dispensed by a qualified provider of medical cannabis as defined by the government of Canada, and that it is for one of the fi ve conditions that we cover it for," he said. "As long as they meet that criteria, we'll accept the claims and pay them." Framework, costs Typical patient consumption var- ies between one to three grams of smoked marijuana per day, at a cost of $8 to 10 per gram — trans- lating to annual totals of $3,000 and $9,000 per patient, said an. "If we're looking at treatment of pain, it's so subjective that, of course, there is going to be a wide gap in terms of the maximum and minimum rates," she said. "It gives you pause when you think that if there's one claim that would take medical marijuana, it could go up to $10,000 a year — it is a substan- tial cost." Any employer adding medical cannabis to its benefi t off erings should expect an increase in plan costs — especially large employ- ers, said Fleming. "Initially, there will defi nitely be an increase in costs of their plans," he said. "Over time, there may be a reduction in other medication costs if people substitute it with cannabis, but I think the next few years will be where we start to gather data to assess if that is in fact the reality." e cost increases for employ- ers off ering the benefi t are still murky, said Jones. "Our recommendation is to start at the lower level and gain some experience with it, and then look to increase the coverage level over time, if that is indeed what the experience indicates makes sense." For now, individual usage will be capped between $1,500 and $6,000 per covered person, per year. It is expected those amounts will provide enough of the drug for the conditions Sun Life is cover- ing, allowing plan sponsors to gain comfort with off ering it as clinical evidence increases, he said. Legal considerations In terms of legal risks, employ- ers should have a solid drug and alcohol policy in place before considering coverage of medi- cal cannabis, said Fleming. Clear communication regarding im- pairment at work and health and safety obligations should also be dealt with prior. As long as an employer is abid- ing by the current legal frame- work, coverage decisions will hinge on cost assessment, said Kiersten Amos, associate at Mc- Innes Cooper in Charlottetown. "It's going to become more and more of a business decision on whether or not it's something that can be covered," she said. "If you've got business reasons to say no, then that's perfectly accept- able, as it is with the decision to cover any other medication." However, declining to cover medical marijuana for other rea- sons could set up an employer for a human rights complaint citing discrimination, said Amos. " e decision should be well- thought-out and reasoned ver- sus being completely arbitrary," she said. MARIJUANA < pg. 1 Addition means increase in cost of plans: Experts Does it actually work? More medical research needs to be completed before medical cannabis is prescribed more generally, according to Christine Than, senior consultant pharmacist and drug solution specialist at Aon in Montreal. "There are a handful of indications that are being supported by more robust studies, and typically the payers who want to pay for medical marijuana would want to reimburse it only for those specifi c indications," she said. Doctors' guidelines for prescribing medical cannabis indicate there is limited evidence to support the drug for many conditions, said Mike Allan, a family doctor and medical professor at the University of Alberta in Edmonton, who recently led a group of 10 physicians in the creation of the Simpli ed Guideline for Prescribing Medical Cannabinoids in Primary Care. There is insuffi cient evidence that medical marijuana has a benefi cial effect on pain, anxiety or social phobias, but many patients are looking to make the move from prescription opioids because it's more natural, he said. The shift, in part, is due to the fact that medical marijuana marketing has been "spectacular," said Allan. "It is not, a lot of the time, factual, but it is exceptional. It's very powerful messaging — a natural product that has multiple positive effects with very little harm."

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