Comp payers in the weeds on dosage, payments for medical pot

With the surge in states permitting the use of medical marijuana, workers compensation payers are forced to grapple with questions for which they have limited or no guidance, including how much cannabis treatments should cost, what the proper dosages are and how marijuana usage will be monitored, experts say.

In the most recent legislative activity, a bill in Maryland — S.B. 854 — passed the state’s Senate on Monday and is now heading to its House of Delegates for consideration, while Hawaiian lawmakers in February tabled both S.B. 1523 and H.B. 1534 — identical bills proposed in January that were opposed by insurance groups.

In the courts, the outcome of disputes regarding the compensability of medical marijuana for pain treatment for injured workers has been mixed. In 2018, the New Jersey Division of Workers' Compensation in a ruling directed comp payers to cover marijuana for injured workers. In Maine in 2017, the state Supreme Court ruled the opposite. More recently, the Supreme Court of New Hampshire on March 8 ruled that a workers compensation appeals board erred when it denied medical marijuana reimbursement for an injured worker, remanding the case back to the lower court.

Experts say comp payers know they are or soon will be on the hook to cover marijuana for injured workers, but the field is muddied with questions: What are the actual costs? What is the dosage? How is it going to be monitored?

“Dosages are part of the problem,” said Dr. Joseph Pachman, Tarrytown, New York-based national medical director of workers compensation claims in the managed care department at Liberty Mutual Insurance Co. “There are no dosages, and that makes it more complicated from the medical perspective.”

“There is no standardization at all, and that is one of the biggest problems with it,” said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president of medical quality for third-party administrator Sedgwick Claims Management Services Inc. “It cannot be prescribed by a physician” as with other drugs — a prescription that comes with a dose and instructions — because it is still a Schedule I illegal drug per the U.S. Food and Drug Administration.

Lawmakers and voters in 32 states have approved medical marijuana for patients, but studies on medically appropriate dosing and efficacy of medical marijuana have lagged behind states’ acceptances because of the federal stance that puts marijuana in the same category as heroin and cocaine.

In most states, the acceptable forms of medical marijuana aren’t regulated, yet some states have limited its use for certain ailments and have limited which components of the marijuana plants are acceptable. Alabama and Mississippi, for example, limit marijuana use to certain kinds of chemicals and ailments, such as for epilepsy patients. California and Oregon laws are more liberal in use and forms. Other states — such as Oklahoma — have yet to create limitations, according to the Washington, D.C.-based National Conference of State Legislatures.

This means the injured worker, with only the recommendation of a physician, in most states is choosing the method of ingesting medical cannabis — from capsules and creams to plants and topical oils — with little oversight, experts say.