Cannabis for Medical Purposes: New Reimbursement Policy

In March 2016, the Minister of Veterans Affairs, the Honourable Kent Hehr, announced a review of VAC’s role in reimbursing Veterans for cannabis for medical purposes. The Spring 2016 Office of the Auditor General report on drug benefits made recommendations to Veterans Affairs Canada to better manage its drug benefits program in a way that considers the health and well-being of Veterans and cost containment.

The Department initiated an internal review in consultation with medical professionals, subject matter experts, licenced providers and Veteran beneficiaries with the following objectives:

• reviewing the Veteran population’s reimbursement data;
• assessing VAC’s internal governance and compliance;
• identifying concerns with Veteran health and well-being; and,
• reviewing other benefits, services and programs that the Department is providing to Veterans authorized for cannabis for medical purposes.

The review’s recommendations include lowering the 10 gram per day limit for reimbursement and including fresh marijuana and cannabis oil.

Veterans Affairs Canada’s new reimbursement policy for Cannabis for Medical Purposes establishes a maximum three gram per day limit for cannabis. In response to feedback from Veterans and the internal review, the Department will now also reimburse Veterans for cannabis oil and fresh marijuana to the equivalent of three grams of dried marijuana per day. Veterans being reimbursed for more than three grams per day of dried marijuana may continue to be reimbursed at that level until May 21, 2017.

The decision to reimburse three grams per day was based on information from consultations and research. The Department brought together a panel of Canadian medical experts who recommended a very cautious approach to the use of cannabis for medical purposes with most indicating one to two grams per day as a reasonable amount for the vast majority of cases. VAC also reviewed current scientific evidence and consulted with Veterans, stakeholders and licensed producers. This decision is also consistent with Health Canada who indicates that the average Canadian is authorized 2.6 grams per day. Two other countries that had available research on marijuana for medical purposes included Israel and the Netherlands. Israel’s average use of cannabis is 1.5 grams per day and it is 0.68 grams per day in the Netherlands.

There will also be an exceptional circumstances process for Veterans whose health practitioner authorizes more than three grams per day of dried marijuana or its equivalent. The process will require additional documentation from medical specialists related to a Veteran’s specific needs. The opinion of the medical specialist must include the rationale for the use of more than three grams, confirmation that there are no contraindications, and an indication that alternative treatments were ineffective or contraindicated. Each claim will be reviewed on a case by case basis. This process is consistent with how the Department administers its other health care benefits.

Additionally, consistent with how the Department administers its other health care benefits, VAC is establishing a rate of up to $8.50 per gram whether taken in dried or fresh marijuana or the equivalent in cannabis oil form. This rate will ensure that what Veterans are charged, and the Department reimburses, is a fair market value price.

VAC completed a review of the advertised prices for cannabis for medical purposes to establish a rate that is based on fair market value and consistent with what other Canadians are paying. As part of its due diligence, the Department conducted a market analysis, consulted with licensed producers and reviewed the average, overall rates reimbursed.

Recognizing that there is limited evidence and research on cannabis for medical purposes, the Department will continue to monitor new developments in research and adjust policy. The Department will also establish an expert advisory committee of health and research professionals to monitor the effectiveness of the reimbursement policy and processes based on research and consultation. In addition, together with the Canadian Armed Forces, the Department will develop a research plan and conduct a study that will strengthen evidence on the effects of marijuana on the health of Veterans.

Timeline

• 2007 - Veterans Affairs Canada (VAC) made the decision to reimburse one Veteran for cannabis for medical purposes on compassionate grounds.
  • Since that time, VAC has been reimbursing the cost of cannabis for medical purposes for Veterans in increasing numbers and at an increased cost.
• 2008 to 2014 - the Department provided reimbursement for the cost of cannabis for medical purposes to Veterans based on Section 4 of the Veterans Health Care Regulations (VHCRs) and in accordance with Health Canada’s Marihuana Medical Access Regulations (MMARs).
  • The MMARs provided limited access to marijuana for a number of conditions and circumstances as defined by Health Canada when authorized by a specialist only.
• April 2014 - Health Canada introduced the Marihuana for Medical Purposes Regulations (MMPRs) which removed limitations related to the authorization for specific conditions and the requirement for authorization by a specialist, amongst other changes; however, still required a medical authorization.
  • With the advent of these new regulations Veterans Affairs Canada subsequently experienced a significant increase in cannabis for medical purposes reimbursements.

Examples

1. A Veteran is currently reimbursed for 10 grams per day of dried marijuana. The Veteran will be reimbursed for 10 grams a day until 21 May 2017. After this date, the Veteran will be reimbursed for three grams per day. In order to be reimbursed for more, a specialist (e.g. a psychiatrist, pain specialist, oncologist) would have to submit, to Veterans Affairs Canada, a rationale for why more than three grams per day are necessary to treat the Veteran’s condition.
2. A Veteran is currently reimbursed for three grams of dried marijuana per day. On November 22, 2016, the Veteran can switch to the equivalent of three grams of dried marijuana in the form of cannabis oil.

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