Will medical marijuana become part of your benefits mix?

BOSTON — Many health plans might not want to touch marijuana with a 10-foot pole, but it might be time to start thinking differently about including cannabis in the benefit mix.

So argues Elizabeth Manzo, an attorney with Lindabury, McCormick, Estabrook & Cooper based in New Jersey who specializes in benefits law with a focus on funds in the construction sector.

"Should your fund cover marijuana products?" Manzo said recently in a presentation at a conference hosted by the International Foundation of Employee Benefit Plans. "We have that conversation, and then I will tell you that most of my construction funds are kind of, 'Heck no,' but I wonder if that's not where the conversation may be going in the future as you continue to see kind of this evolution and this change in feeling about marijuana."

In surveying the dozens of states that have been moving toward decriminalizing or legalizing marijuana for medicinal or recreational purposes, Manzo sees a seismic shift under way.

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For the benefits world, the medicinal uses of cannabis are of the greatest interest, be it the THC compound found in marijuana that causes the sensation of feeling high, or cannabidiol — CBD which doesn't produce a high but has become a popular additive to food and beverages for its purported therapeutic value.

Ben Nelms/Bloomberg

Congress took a major step toward advancing CBD when it lifted the ban on hemp production in last year's farm bill. Still, the FDA maintains that it is illegal to add CBD to food products, and state policies vary widely.

However, when no less of a critic of legalization than former House Speaker John Boehner joins the board of the cannabis company Acreage Holdings and explains that "my thinking on cannabis has evolved," Manzo sees the writing on the wall.

The country is slowly seeing a cutting away of cannabis restrictions “and this acknowledgement that it's coming," Manzo said.

That could translate into an increasing demand for benefits coverage for cannabinoid treatments, particularly when researchers are exploring new applications for CBD and marijuana to help with conditions as varied as headaches, Parkinson's disease and multiple sclerosis.

Manzo also related a conversation she had with the head of an opioid treatment facility who touted the potential of cannabis as a "step-down drug" that could be helpful in the struggle to recover from addiction to more dangerous drugs.

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Further changes in federal policy on the matter could dramatically accelerate the process. For all the work that researchers are doing exploring the potential health applications of cannabis, they have been operating without federal funding. And the FDA's stance has kept most plans from adding a cannabis benefit.

"Most health plans are not covering it right now because it's not approved by the FDA as medicine," Manzo said. "You have private health insurers that are not required to cover things that are not FDA-approved drugs."

Still, lawmakers in states that have moved toward legalization are calling for rules that would require health plans to cover medical marijuana. Judges in some states have also ruled that workers' compensation insurance carriers reimburse employees who were hurt on the job and whose treatment involved cannabinoids of some sort.

The FDA has also taken a historic step with the approval of the anti-seizure drug Epidiolex, the first drug derived from a cannabis plant compound that the agency has cleared.

Then, too, there is a renewed push in the U.S. Congress to enact bipartisan legislation that would effectively set a federal policy of deferring to states to set their own marijuana policies.

Taken together, Manzo sees a future — if not the present — where health plans will have to begin thinking seriously about offering cannabis coverage.

"At this point in time I don't have a single fund that is realistically considering covering either for a number of different reasons," Manzo said, "but I wonder if that's not where the conversation is going."