Since the spring of 2017, there has been an addition to the list of qualifying conditions eligible for medical marijuana. There has also been an increase in the number of patients and providers eligible and registered under the program. This post will serve as an update on the issue and how to “weed” through the options for denials in New York State workers’ compensation claims.
The most recent list of medical providers for medicinal marijuana can be found here.
Currently, there are 35 Western New York medical practitioners on the list. Back in April, there were 900 Registered Practitioners and 16,000 registered patients in the program. As of the end of November, there are 1,349 Registered Practitioners and 37,353 registered patients in the Medical Marijuana Program. The conditions which are necessary and approved for the program include: cancer, HIV infection or AIDS, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, multiple sclerosis, spinal cord injury with spasticity, epilepsy, inflammatory bowel disease, neuropathy, Huntington’s disease, post-traumatic stress disorder or chronic pain (as defined by 10 NYCRR §1004.2(a)(8)(xi)). The severe debilitating or life threatening condition must also be accompanied by one or more of the following associated or complicating conditions: cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasms. “Chronic Pain is described as lasting three-plus months beyond onset or an anticipated three-plus months. PTSD has been added to the list effective November 11, 2017.
The authorized medical practitioner must clearly state on the prescription the: authorized brand, form (liquid, vapor oil, inhaler and capsules), how it is to be administered, and any limitation on the dosage. It is required that a patient follow up every 90 days to remain eligible for the prescription. In Western New York, Med Men and Pharma Cann are registered organizations. The price is set by the Registered Organization.
According to the New York State website for medical marijuana, only one-third of patients certified for the medication actually are receiving it. The average cost projection was $200 per month. Generally, the medical profession should be using medical marijuana as a replacement to opiates. The FDA has not approved marijuana as a safe and effective drug for any indication. The FDA has not approved any product containing or derived from botanical marijuana for any indication. This means that the FDA has not found any such product to be safe or effective for the treatment of any disease or condition. The agency has, however, approved two drugs containing a synthetic version of a substance that is present in the marijuana plant and one other drug containing a synthetic substance that acts similarly to compounds from marijuana but is not present in marijuana (Marinol, Syndros, and Cesamet).
If you receive a MG-2 or C-4 AUTH requesting authorization for medicinal marijuana, please feel free to reach out to determine the potential defenses and mechanism for reimbursement in order to protect your interest.