Does Medicare Cover Medical Marijuana?

Medicare will cover only medications approved by the Food and Drug Administration.

Medical marijuana isn’t FDA-approved, and it is still considered an illegal drug by the federal government.

Therefore, Medicare won’t cover the cost of purchasing a medical marijuana card or buying medical marijuana at a dispensary.

This is true even if you live in a state where medical marijuana is legal.

However, certain cannabinoid medications — such as Syndros and Epidiolex — may be covered by Medicare drug plans because these products are FDA-approved.

The marijuana plant contains more than 60 different types of cannabinoids. Two cannabinoids have been studied for medicinal uses: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

Medical marijuana may not be FDA-approved, but four cannabinoid medications are.

Other than the four products listed below, the FDA has not approved any other cannabis, cannabis-derived or CBD products on the market.

The fact that these four drugs are FDA-approved doesn’t mean Medicare will cover the cost.

Medicare’s coverage of cannabinoid medications depends on the type of prescription drug plan you have.

For example, GoodRX, a health care company that tracks prescription drug prices in the United States, notes that most Medicare plans will not cover Syndros.

Because Syndros is a name-brand drug, it is quite expensive without insurance coverage. GoodRx estimates a single prescription of Syndros can cost up to $1,342.

However, some Part D and Medicare Advantage plans will cover part of the cost of Syndros.

For example, Independent Health is an insurance company that offers six Medicare Advantage plans.

All six cover Syndros as a Tier 4 drug, according to the company’s 2022 Individual Part D Formulary.

Syndros has an estimated $40 copay with plans from Independent Health, according to GoodRx. Plan deductibles may also apply.

It’s important to note that even if your Part D or Medicare Advantage plan covers cannabinoid medications, you may still need to get prior authorization. This means you need to contact your plan in advance and your health care provider may need to fill out paperwork describing why you need the prescription.

This is only an example. Medicare Advantage and Part D plans tend to serve specific coverage areas. Independent Health, for example, is available only in eight counties in Western New York.

It’s important to check your own plan details and formulary to see if cannabinoid medications are covered.

As of 2022, 19 states have full legalization and 19 others have enacted medical marijuana programs.

In states where only medical marijuana is legal, you must get a medical marijuana card in order to purchase the drug.

The process for obtaining a medical marijuana card varies by state.

However, a few basic rules apply.

As with any prescribed medication, you need a reason for a doctor to recommend medical marijuana. Each state has its own list of ailments that can be legally treated with cannabis, such as pain, PTSD or cancer.

Next, you will need to ask your doctor if he or she is comfortable issuing you a medical marijuana card. You can also look online for medical professionals who are registered with your state’s cannabis program.

Some states require you to sign up with the state-maintained registry of medical marijuana patients. In other states, this step is optional.

Finally, after you’ve received your medical marijuana card, you will need to locate a nearby dispensary to purchase the product.

If you think medical marijuana could be a viable treatment option for you, talk to your doctor. He or she will be able to evaluate whether medical marijuana treatment is right for you.