Canadian insurer accepts pot claim

by Nicolas Heffernan17 Mar 2015
A Sun Life decision to pay an Ontario student’s medical marijuana claim could open the floodgates for pot coverage in Canada.

The Toronto-based insurer decided to cover cannabis for Jonathan Zaid, a 22-year-old University of Waterloo student, who says marijuana is the thing that helps him concentrate long enough to get through his studies.

Zaid has a doctor’s authorization so he can legally access the drug, but couldn’t afford the $30 a day cost of the drug.

After speaking to his school and Sun life, the insurer covered the drug for Zaid.

“Currently medical marijuana is not considered an eligible benefit in our standard drugs plans,” Sun Life said in a statement. “We do consider, and where possible, accommodate requests for exceptions if directed by the plan sponsors."

In December, Zaid submitted his first claim for medical marijuana and a vaporizer, an alternative device to smoking. He has already been reimbursed more than $2,000.

Government health plans and private insurers have been under pressure from Canada’s medical marijuana community to cover the drug like other treatments. But until now insurers have been reluctant to budge on their position.

When accompanied by a doctor’s authorization marijuana is a legal treatment for patients in Canada. But since it hasn’t been subjected to the rigorous research trials that most pharmaceuticals undergo, the medical community and Health Canada do not recognize it as a valid form of treatment.

Cannabis also doesn’t have an industry standard Drug Identification Number (DIN), which is usually required before a medication is authorized for sale and reimbursement.

The lack of a DIN is a sticking point for doctors.

Zaid found this issue when he was trying to receive a doctor’s authorization to treat New Daily Persistent Headache, a chronic condition that causes severe recurring migraine-like pain that causes sensitivity to light and noise and disrupts sleep.

Zaid was diagnosed at 14 and tried 48 different pharmaceuticals to manage the constant pain.

“Managing a chronic debilitating condition is not an inexpensive thing to do, pharmaceutically at least,” he said to the Huffington Post.

“At the same time from the insurance company’s perspective, it actually saved money because my sleep medication from the U.S. was $15 a day, my pain medication was $10 a day [and] my mood medication was $20 a day.”

After his success with Sun Life, Zaid has started an organization, Canadians For Fair Access To Medical Marijuana to push for more insurers to cover medical pot.

“Now we know Sun Life can cover it if the employer wants it but employers will only want it if workers argue for it,” he said to the Huffington Post, adding that Sun Life now has a system in place to process such claims.