New Jersey Man (Kind of) Wins Medical Marijuana Insurance Coverage

Health insurance coverage has long been a source of exasperation for medical marijuana patients in the United States. For more than 20 years, mainstream insurance companies have refused to cover anything having to do with cannabis medicine. In Canada, some of the nation’s biggest companies are now moving to include medical marijuana in their employee health care plans. South of the border, though, signs of progress have been few.

So imagine my surprise when I read this recent headline:

Judge: Insurance company must pay for medical marijuana for injured N.J. worker

Insurance coverage for medical cannabis would be a massive step forward, especially for low income patients who struggle to cover the cash-only, out-of-pocket costs of medical cannabis.

Insurance coverage would be a massive step forward. In New Jersey, an ounce of medical marijuana costs around $400.

In New Jersey, an ounce of medical cannabis sets you back roughly $400 plus tax. Which is why that headline was such bombshell. It almost sounded too good to be true.

Was this the long-awaited breakthrough? Would health insurers finally offer medical cannabis coverage?

Not exactly. But the case does represent a half-step of progress.

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The case in question was a workers compensation matter. Andrew Watson, a 39-year-old worker at the 84 Lumber outlet in Manahawkin, injured his left hand while using a power saw at the building supply warehouse in 2008. Watson suffered lingering neuropathic pain in the hand long after the incident. After years of opioid use for the pain, Watson enrolled in the state’s medical marijuana program in 2014. The cannabis allowed him to cut down his opioid use and treat the pain more safely.

Watson submitted invoices and receipts for the medical cannabis to his employer’s insurance provider for reimbursement. Those requests were denied. Watson took the dispute to court.

And he won.

“While the court is sensitive to the controversy surrounding the medicinal use of marijuana,” Judge Ingrid L. French concluded in her ruling, “whether or not it should be prescribed for a patient in a state where it is legal to prescribe it, is a medical decision that is within the boundaries of the laws in the State of New Jersey. In this case, there is no dispute that all of the credible evidence presented confirms that this Petitioner is an appropriate candidate for New Jersey’s medical marijuana program.”

Precedent? Not a legal one, sorry

So is this a “precedent-setting case,” as  some have suggested? Leafly reached out to Phil Faccenda, who represented Watson in the case.

Because the respondent (i.e., the insurance company) chose not to appeal the judge’s decision, “this particular case won’t set a legal precedent,” he said.

“It would have been better if they challenged the ruling,” Faccenda told Leafly. “Until a case is appealed there is no legal precedent. So this ruling is not legally binding, but it is very persuasive.”

Medical cannabis users can take some comfort from Watson’s symbolic verdict. Faccenda said he believes a similar case will eventually be appealed, wind its way through the system, and set a binding legal precedent.

Dispensaries watching the fallout closely

Medical cannabis businesses in New Jersey are watching closely to see how the issue ultimately shakes out. George Schidlovsky is Executive Director  of Compassionate Sciences ATC, the state’s largest dispensary by volume. He was quick to highlight why insurance companies might benefit from this progress too.

“It is only a matter of time before insurance companies recognize medicinal cannabis like any other medicine they reimburse for,” Schidlovsky told Leafly. “Medicinal cannabis is showing significant benefits as an alternative to mainstream pharmaceutical medicines that cost significantly more, have addictive features and in some cases lead to unforeseen deaths due to abuse.”

State-licensed medical cannabis dispensaries like his own, Shidlovsky said, “are prepared to work with insurance companies on reimbursement and co-pay processes” that benefit both patients and their insurers.

It’s worth noting the number of trade publications–insurance, workers compensation, and legal journals–that have covered this case. That’s perhaps the best barometer to gauge the significance of the case and its potential impact on future medical marijuana coverage in New Jersey and across the nation.



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