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Medical marijuana use in workers comp looms: Panel

Medical marijuana

CHICAGO — The landscape for the use of medical marijuana and cannabinoids is changing in workers compensation, and it’s likely that more insurers will be required to pay for this in the near future, experts say.

At the 2019 CLM Workers Compensation Conference Wednesday in Chicago, panelists shared their differing perspectives on the use of marijuana and CBD in the workers comp space and how this may change as states consider new legislation on the medical and recreational use of marijuana.

Dr. Carlos Giron, CEO physician of the Pain Institute of Georgia in Macon, Georgia, said he was skeptical of the use of medical marijuana and CBD to treat pain. However, when patients in his practice — about 90% of whom are workers comp claimants — began obtaining their own CBD products from friends and family in states where it was legal and rejecting prescriptions for more traditional medications, he took notice.

“I started to see an opportunity to use this to improve patients’ safety, and the results I’ve seen as a physician … have been nothing short of remarkable,” he said.

In the past four months, Ronald Mazariegos, vice president of claims and vendor management at Arrowood Indemnity Co. in Charlotte, North Carolina, said the company’s workers compensation book has started to see more requests for the administration of medical marijuana.

“In certain jurisdictions, carriers have been mandated to reimburse,” he said. “Personally, I know about a half dozen carriers and (third-party administrators) reimbursing for medical marijuana, and many said they reimburse the claims directly.”

There are only a handful of states where marijuana is legal in workers compensation and reimbursement is required, said Jeremy Buchalski, an associate in the New York City office of Wilson Esler Moskowitz Edelman & Dicker LLP. New Mexico, requires workers comp insurers to reimburse for medical marijuana and has added it to the fee schedule; New York and New Jersey courts have held that employees should be reimbursed for medical marijuana to treat a compensable condition, he said. Legislation regarding workers compensation reimbursement for medical marijuana is pending in multiple states as well, including Maine, Maryland, Vermont, New Jersey, New York and Hawaii.

The governor of New York has also expressed his support for the workers compensation board in the state to authorize reimbursement for medical cannabis,” said Jeremy Unruh, director of regulatory and public affairs at Chicago-based PharmaCann LLC.

However, patients shouldn’t be able to just go to a vape shop and present the bill to the insurer, Dr. Giron said.

“The key is to know what it is that the patient is receiving,” and what their dose regimen and dosing schedule is, if and when the time comes that this is commonly reimbursed in workers comp.

Mr. Mazariegos said from an insurers perspective, he’s concerned about going down a “a slippery slope” if workers can just submit a receipt from a dispensary and receive reimbursement.

In Illinois, the state’s opioid alternative pilot program, which took effect about three months ago, allows individuals who otherwise would be prescribed opioids to opt for a prescription for marijuana to be filled at a dispensary. Mr. Unruh said the pilot also set up a marijuana tracking system to collect data on the risks and benefits to allow for informed public policy decisions in the future.

One challenge that needs to be addressed from the physician perspective, says Dr. Giron, is the lack of federal or clinical guidelines to use as a reference for dosing. For his use of CBD, he said he’s been taking a clinical approach to find the right dosage for different patients, but says in those who use CBD, he has seen a more than 90% rate of clinical improvement. He also said he has been able to reduce his patients’ use of opioids by 60% to 65% through the use of CBD.

“What we’ve seen in the last year and a half is a reduction in not just opioids, but all accompanying medications that come with it — muscle relaxants, anti-inflammatories benzodiazepines, sleep medications,” he said. “Every time I would remove or reduce some of those, not only would function improve, the cost of their claims also went down and their functional status improved.”

Mr. Buchalski said that with pending legislation to expand medical marijuana in 20 states and 10 states considering recreational marijuana, he believes the future will be medical marijuana in workers comp.

“The trend is obvious,” he said.



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