Does presciption insurance pay for cbd oil

Does Insurance Cover CBD Oil?

Most insurance companies won’t cover the cost of CBD.

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With research proving the health benefits of CBD oil, more individuals are opting for it as a supplement, causing a jump in its popularity.

However, the high price of CBD is a huge concern, making many users turn to cheaper options that do not yield effective results.

Between the high prices and inferior products, many wonder if their health insurance policy covers the expense.

This article discusses whether or not your insurance program will cover CBD oil and why.

Table of Contents

The Bottom Line: Will Health Insurance Companies Cover CBD Oil?

Right now, the answer to this question is no.

Currently, most health insurance agencies do not cover CBD oil, even when a physician prescribes it.

Many more physicians are taking notice of CBD’s benefits and its potential for treating various ailments. So far, CBD does not seem to have many side effects. As a result, doctors have started recommending CBD as a treatment along with conventional medications. That’s when patients wonder whether insurance agencies pay the cost.

However, in certain regions, CBD may be covered by private insurance companies in limited cases.

In the US, a prescription drug called Epidiolex is the exception. It’s the one prescription drug containing CBD that is FDA-approved; it’s used in treating a rare form of epilepsy.

In other countries, such as Canada or the UK, another prescription CBD-based medication called Sativex may be covered by insurance.

Why Won’t Health Insurance Agencies Cover CBD?

Even though there’s more evidence backing the medicinal properties of CBD oil, and even if doctors are prescribing it to their patients, health insurance still does not cover the cost. This makes one wonder why most other pharmaceutical drugs — with higher price tags and more severe side effects — are covered, and CBD oil isn’t.

CBD is Not FDA-Approved

Before getting released into the market, any new drug must get the FDA’s approval so that the doctors can legally prescribe it to their patients.

CBD is still considered a New Dietary Ingredient (NDI). Extensive lab tests and research must be submitted and reviewed before the FDA approves a new drug.

Insurance companies won’t insure anything that isn’t FDA-approved. The process required for approval is lengthy and expensive.

CBD is a Cannabis Product

Cannabis (hemp and marijuana) is still met with uncertainty. Hemp is federally legal, but only recently. The Farm Bill passed into law in 2018, making hemp and its derivatives legal — as long as it contains less than 0.3% THC.

Marijuana is still a Schedule 1 drug, federally and in some states. Because both hemp and marijuana teeter on legality, many companies shy away from such products. It’s not just insurance companies — many shipping companies, even local ones in states where marijuana is legal, won’t deliver it.

Learn More About CBD Laws All Over The World.

What Alternative Options Are Available For Patients?

Currently, patients interested in purchasing CBD oil for its medicinal benefits must meet these needs from their own pockets. No financial assistance is available for those who wish to use CBD products, even with a doctor’s prescription.

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Because CBD is unregulated, everyone needs to be extra cautious when purchasing CBD oil. High-quality CBD products can go beyond $100 per bottle. Certain CBD companies are a scam and have been caught with little to zero CBD compounds in their products.

To avoid buying fake CBD products, people must purchase them from reputable sources. It’s essential to find out the company’s authenticity and conduct careful research before investing in CBD.

Benefits of Using CBD Oil

There’s been a lot of research on CBD over the past few decades. A lot of this research has been promising, and there are a lot of acknowledged health benefits of CBD.

The only health conditions insurance will cover CBD as a treatment for are those approved by the FDA for drugs like Epidoliex or Sativex to treat. This primarily involves epilepsy and low appetite as a result of chemotherapy.

Here are a few of the proven benefits research has uncovered for CBD:

Summary: CBD & Insurance Companies

The government doesn’t ban CBD products but insurance companies won’t reimburse the costs incurred for using them for medical purposes.

So even if physicians acknowledge the health benefits of CBD oil and prescribe it to their patients, insurance policies are not willing to cover the cost needed to procure it.

CBD oil is reasonably priced compared to many other pharmaceutical drugs, even after insurance coverage.

Why Health Insurance Won’t Pay for Medical Marijuana

Elizabeth Davis, RN, is a health insurance expert and patient liaison. She’s held board certifications in emergency nursing and infusion nursing.

Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more.

James Lacy, MLS, is a fact-checker and researcher. James received a Master of Library Science degree from Dominican University.

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If you live in a state where medical marijuana use has been legalized (37 states and DC as of late 2021), it’s tempting to assume that your health insurance will pay for it like other drugs prescribed by your healthcare provider. However, you’d be wrong; health insurance won’t pay for medical marijuana even in states where its use has been legalized.

This article will explain why health insurance won’t pay for medical marijuana when it will pay for all sorts of other drugs, many arguably more dangerous and prone to abuse.

Medical Marijuana Is Federally Illegal and a Schedule I Drug

Health insurers in the United States won’t pay for anything that’s technically illegal. Most health insurance policies include an illegal acts exclusion saying that health issues occurring due to or in association with your voluntary involvement in an illegal act are not covered (some states limit or prohibit these sort of exclusions ).

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Even though medical marijuana has most likely been legalized in the state where you live, it’s still classified by the federal government as a schedule I controlled substance as defined by the Controlled Substances Act. Schedule I drugs have “no currently accepted medical use,” according to the Drug Enforcement Administration (DEA), and it’s still illegal to use marijuana in terms of federal law

In addition to health plan illegal acts exclusion clauses, another issue arises due to marijuana’s Schedule I designation. Schedule I controlled substances can’t be prescribed by healthcare providers the way other medications are.

Healthcare providers who prescribe controlled substances must be registered with the Drug Enforcement Administration and have a DEA number. Prescribing a Schedule I drug, even in a state where medical marijuana has been legalized, would place a healthcare provider at risk of having his or her DEA registration revoked. Even if medical marijuana has been legalized in your state, as long as it’s considered a Schedule I drug by the federal government, prescribing it would put your healthcare provider at risk of losing his or her ability to prescribe even simple controlled substances like sleeping pills and cough syrup with codeine.

For this reason, most healthcare providers don’t prescribe medical marijuana. In states that have legalized its use, healthcare providers recommend medical marijuana rather than prescribe it (Cigna describes how a doctor can write a “certificate” that the patient can take to a medical marijuana dispensary). That brings us to stumbling block number two.

Health Insurance Won’t Pay for Medical Marijuana If It’s Not on the Drug Formulary

Even if the U.S. were to change marijuana to a schedule II or III drug—thereby allowing its prescription and decriminalizing its medical use across the country—your health insurance company probably still wouldn’t pay for your medical marijuana. Likewise, if congressional action were to remove marijuana from the list of controlled substances altogether, your health plan probably still wouldn’t pick up the tab for your Alice B. Toklas brownies even if your healthcare provider recommended them.

Each health plan has a drug formulary, which is a list of medications it covers for health plan members. Your health plan’s pharmacy and therapeutics committee would have to add marijuana to its drug formulary before it would be a covered benefit of your health insurance.

It would be highly unusual for a health plan to add a drug to its formulary if the drug hasn’t been FDA approved. Getting new drug approval from the FDA requires clinical studies to determine both the drug’s safety and that the drug is effective. Clinical studies are complicated and expensive to perform. So, when the FDA grants a new drug approval, it also grants a period of time in which the company given the new drug approval has exclusive rights to manufacture and sell the drug in the United States.

If you think it costs a lot now, wait until Pfizer, Merck, AstraZeneca or another big pharma company gains the exclusive right to bring marijuana to market in the United States.

Without FDA approval, it won’t get on your health plan’s drug formulary, so your health insurance won’t pay for medical marijuana. The process of getting marijuana approved would almost assuredly involve big pharma, exclusive marketing rights, and exorbitant costs. You can read more about this in an article about marijuana that the FDA published.

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The FDA has, however, approved Marinol (in 1985), Cesamet (in 2006), and more recently, Syndros (in 2016). All three contain a synthetic form of THC. In 2018, the FDA approved Epidiolex, a CBD oral solution for treating seizures associated with two forms of epilepsy. Although these drugs are not the same thing as cannabis, they can be prescribed just like any other FDA-approved medication, and do tend to be covered by health insurance plans.

Health Insurance Won’t Pay for Medical Marijuana as an Herbal Remedy

If marijuana was to be reclassified so that it wasn’t a controlled substance at all, it might become available without a prescription. However, that still wouldn’t result in medical marijuana being covered by health insurance.

When a drug becomes available without a prescription, it’s removed from health plan drug formularies and you’re expected to pay for it yourself. Does your health insurance currently reimburse you for over-the-counter medications like Tylenol? Most don’t. Does it cover herbal remedies like St. John’s wort or echinacea? That’s unlikely.

In this situation, patients who would benefit from using marijuana would be able to buy it over-the-counter like any other herbal remedy. As they are now, those patients would be highly motivated to find a way to pay for it themselves. Why would your health insurance want to set a precedent of paying for over-the-counter drugs or herbal remedies that you’re willing to pay for yourself?

Will Things Change?

Even if marijuana were to be reclassified to a lower schedule or congressional action removed it from the list of controlled substances altogether, that wouldn’t be like waving a magic wand. Your health plan wouldn’t magically start paying for your medical marijuana a month or two later. Instead, it would be the beginning of a long, slow, process.

If the process ended up with marijuana being an FDA approved drug, it might eventually be covered by your health plan as a prescription drug on its drug formulary. However, that would be years, not months, down the road. If, even more surprisingly, marijuana ended up as an herbal remedy not requiring FDA approval, it remains highly unlikely that your health insurance would pay for it.

Summary

There’s more than one reason why health plans won’t pay for medical marijuana. Marijuana is federally illegal and classified by the DEA as a Schedule I drug. And without FDA approval, health plans wouldn’t add it to their formularies even if the federal government legalized it and the DEA rescheduled it.

A Word From Verywell

Although health insurance does not cover medical marijuana, the majority of states have legalized medical marijuana. So while your health insurance won’t pay the bill, you likely have access to medical marijuana if you need it. And as time goes by, it’s possible that the rules and regulations around marijuana could be relaxed, resulting in lower costs for consumers.