Commercial

Medical Policy

Title:

Marijuana for Medical Use

Policy #:

00.01.48d

Policy

Company benefit contracts indicate that in order for a drug to be eligible for reimbursement consideration the US Food and Drug Administration (FDA) must first issue final approval for the product to be marketed for a specific approved condition or diagnosis. To date, the FDA has not approved the use of marijuana for medical use; therefore, marijuana for medical use is considered a benefit contract exclusion and is not eligible for reimbursement consideration.

Although state mandates, such as the "New Jersey Compassionate Use Medical Marijuana Act" and the Pennsylvania "Medical Marijuana Act" recognize that marijuana use is not against the law when prescribed by a professional provider based on lack of FDA approval, such state mandates do not impact the Company's position and, therefore, medical use of marijuana is not eligible for reimbursement.

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, marijuana for medical use is a benefit contract exclusion for all products of the Company.

Description

For the purpose of this policy, the term marijuana refers to the dried leaves and flowers of Cannabis sativa plant, and any mixture or preparation thereof, and does not include The US Food and Drug Administration (FDA) approved drugs (e.g., dronabinol [Marinol^™ and Syndros^™] or nabilone [Cesamet®]) that may contain active ingredients that are present in marijuana.

The FDA is responsible for the approval and marketing of drugs for medical use, including controlled substances. To date the FDA has not approved marijuana for the treatment of any disease or condition.

Medical use of marijuana refers to the use of marijuana, including components of marijuana as a professional provider's recommended form of medicine or herbal therapy, to treat individuals with chronic or terminal illnesses. Medical marijuana can be consumed via smoke inhalation, edible , vapor (heated until active ingredients are released), or as a Tetrahydrocannabinol (THC) rich liquid or residue extract.

Many states have authorized the use of marijuana for medical treatment. In those states where its use for medical treatment is not prohibited, it is typically prescribed by a professional provider to manage pain related to chronic diseases or cancer and as a medical treatment to address a number of conditions including but not limited to AIDS wasting, epilepsy, neuropathic pain, spasticity associated with multiple sclerosis, and cancer and chemotherapy-induced nausea. If a professional provider in a state where the use of medical marijuana has been authorized believes that the use of marijuana will be beneficial as a medical treatment, and the person for whom it is being prescribed is a legal resident of that same state, marijuana may be prescribed for certain such state-approved conditions. The person is given documentation that grants eligibility to participate in the medical marijuana program and is listed in a state directory as a person who is able to purchase marijuana with a professional provider's prescription from an authorized medical marijuana dispensary.

References

Company Benefit Contracts.

National Institutes of Health (NIH). National Institute on Drug Abuse. Marijuana - Drug Facts. [NIH Web site].March 2016. Available at:

http://www.drugabuse.gov/publications/drugfacts/marijuana. Accessed August 2, 2023.

New Jersey Senate Bill 119, dated JANUARY 7, 2010. Available at: https://www.njleg.state.nj.us/2008/Bills/PL09/307_.HTM. Accessed August 2, 2023.

Pennsylvania General Assembly. Medical Marijuana Act, dated April 17, 2016. Available at: https://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2016&sessInd=0&act=16. Accessed August 2, 2023.

US Food and Drug Administration (FDA). U.S. Department of Health and Human Services. Researching the Potential Medical Benefits and Risk of Marijuana. [FDA web site]. 07/13/2016. Available at: https://www.fda.gov/newsevents/testimony/ucm511057.htm. Accessed August 2, 2023.

US Food and Drug Administration (FDA). U.S. Department of Health and Human Services. FDA and Cannabis: Research and Drug Approval Process. [FDA website]. 02/09/2016. Available at:
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421163.htm. Accessed August 2, 2023.

US Food and Drug Administration (FDA). U.S. Department of Health and Human Services. FDA and Marijuana: Questions and Answers. [FDA website]. 09/30/2015. Available at: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm. Accessed August 2, 2023.

Coding

CPT Procedure Code Number(s)

N/A

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

N/A

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From 00.01.48d:

08/23/2023	This policy has been reissued in accordance with the Company's annual review process.
07/12/2021	This version of the policy becomes effective 07/12/2021. The policy has been reviewed and reissued to communicate the Company's continuing position on marijuana for medical use.

Revisions From 00.01.48c:

10/09/2019	This policy has been reissued in accordance with the Company's annual review process.
09/26/2018	This policy has been reissued in accordance with the Company's annual review process.

Effective 10/05/2017 this policy has been updated to the new policy template format.

Version Effective Date:

7/12/2021

Version Issued Date: