Just in Case You Were Curious. . .
MEDICAL USE OF MARIJUANA
Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member’s specific benefit plan. This Medical Coverage Guideline must be read in its entirety to determine coverage eligibility, if any.
The section identified as “Description” defines or describes a service, procedure, medical device or drug and is in no way intended as a statement of medical necessity and/or coverage.
The section identified as “Criteria” defines criteria to determine whether a service, procedure, medical device or drug is considered medically necessary or experimental or investigational.
State or federal mandates, e.g., FEP program, may dictate that any drug, device or biological product approved by the U.S. Food and Drug Administration (FDA) may not be considered experimental or investigational and thus the drug, device or biological product may be assessed only on the basis of medical necessity.
Medical Coverage Guidelines are subject to change as new information becomes available.
For purposes of this Medical Coverage Guideline, the terms “experimental” and “investigational” are considered to be interchangeable.
Description:
Medical marijuana is marijuana used in the treatment of certain debilitating medical conditions or diseases. The Arizona Revised Statutes Title 36 Chapter 28.1 Arizona Medical Marijuana Act Definitions section (36-2801) defines these medical conditions as:
▪ Cancer
▪ Glaucoma
▪ Positive status for Human Immunodeficiency Virus (HIV)
▪ Acquired immune deficiency syndrome
▪ Hepatitis C
▪ Amyotrophic Lateral Sclerosis (ALS)
▪ Crohn’s Disease
▪ Agitation of Alzheimer’s Disease
▪ A chronic or debilitating disease or medical condition that produces cachexia or wasting syndrome, severe and chronic pain, severe nausea, seizures (including those characteristic of epilepsy) or severe and persistent muscle spasms (including those characteristic of Multiple Sclerosis).
▪ Any other medical condition added by Arizona Department of Health Services (DHS)
Medical marijuana may be obtained from an Arizona state licensed dispensary and is available as a product to be smoked or as an edible food product. The Food and Drug Administration (FDA) has not approved marijuana for the treatment of any medical condition or disease.
Criteria:
Medical marijuana, marijuana and any costs or fees associated with obtaining medical marijuana, such as obtaining an initial or renewal registry identification card, even when prescribed and obtained in compliance with state law(s) is considered a benefit plan exclusion and not eligible for coverage.
Medical marijuana dispensaries are not Blue Cross Blue Shield of Arizona eligible providers and, therefore, medical marijuana obtained from a state licensed dispensary is not eligible for coverage.
Resources:
1. State of Arizona. AZ Statute Title 9 Health Services Chapter 17 Department of Health Services – Medical Marijuana Program Draft.
2. Blue Cross Blue Shield of Arizona. Benefit Plan Booklet.
3. State of Arizona. Arizona Revised Statutes Title 36 Public Health and Safety Chapter 28.1 Arizona Medical Marijuana Act 36-2801 Definitions. Accessed 01/26/12.
4. Arizona Department of Health Services. Medical Marijuana Program Rules & Statutes. Accessed 01/26/12.
MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 03/10/11
SECTION: MEDICINE LAST REVIEW DATE: 02/21/12
LAST CRITERIA REVISION DATE: 02/21/12
