New Mexico Health Insurers Sued Over Medical Cannabis Coverage

It is not unusual for medical cannabis patients to pay the entire cost of their medications out of pocket. In fact, this is the rule. Health insurance companies do not want to get involved. But that may change, thanks to a lawsuit recently filed in New Mexico. The lawsuit seeks to force health insurers in the state to abide by a new state law requiring them to cover medical cannabis when it is recommended for a behavioral health issue.

Apparently, New Mexico legislators enacted legislation to guarantee that mental health patients do not have to bear any out-of-pocket expenses for their treatment. As a result of that law, a cannabis company active in New Mexico sent health insurers a letter asking them to affirm their plans for complying with the law.  There were no responses to the letter. Therefore, the company joined forces with five medical cannabis patients to file a class action lawsuit.

In a Tough Position

In fairness to the health insurers, they are in a tough position. They run the risk of upsetting federal regulators by getting involved with medical cannabis. On the other hand, they will definitely stir up trouble with state lawmakers by not complying. It is a no-win for them.

Health insurers also go to great lengths to make sure they are not paying for ineffective treatments. Though medical cannabis may be effective as a treatment for certain types of behavioral health problems, the jury is still out. There is no science health insurers can look to as a gauge of whether paying for certain treatments makes sense.

Nonetheless, New Mexico health insurance companies that provide coverage for behavioral health treatments are now obligated by law to make sure that patients do not experience any out-of-pocket costs as the result of seeking those treatments. This includes medical cannabis, when appropriate.

Just for Behavioral Health

It should be noted that the New Mexico statute only applies to behavioral health issues. Perhaps the most common such issue is post-traumatic stress disorder (PTSD). Medical cannabis is approved as a PTSD treatment in New Mexico and because it is considered a behavioral health issue, tens of thousands of patients in the state should now have access to cannabis without any out-of-pocket expenses.

The class action lawsuit filed in New Mexico aims to guarantee that. Plaintiffs want proof that state insurers are going to comply. If they succeed, and health insurance companies comply without experiencing any federal resistance, it could open the door to other states looking to do similar things.

A Cash Only Business

Right now, medical cannabis is largely a cash-only business throughout the country. This is certainly the case in Utah. When patients visit a clinic for help in obtaining their medical cannabis cards, they need to pay for the visit themselves. Likewise, they bear the entire cost of purchasing their medications.

Getting insurance companies on board would certainly eliminate one of the biggest accessibility issues in medical cannabis. It would make high prices a non-factor – at least from the consumer’s perspective anyway. The downside to this is that insurance involvement would actually hike prices as insurance companies seek to limit reimbursements. Ultimately, health insurance premiums would go up as well.

New Mexico health insurers have a decision to make. They can either comply with the new law or fight it. Perhaps the lawsuit filed against them will settle the question in short order. And if so, certain groups of medical cannabis patients in the state will no longer have to pay anything for their medications.






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