If you asked that question a few years ago, you would now be staring at a blank page!
In 2020 HIF became the first major private health insurer in Australia to publicly declare support for medical cannabis and one of the first to offer rebates for the treatments under their extras policies.
Today, most Australian private health insurers cover medical cannabis – in some form – in their extras packages. Australian health funds are primarily focused on the needs of their members and do have a history of responding more quickly to consumer concerns and demands than what the government can.
Private Health Funds have various levels of cover; and even with the highest level, a lot of patients prescribed medical cannabis are out of pocket somewhere along their supply chain…
Medicare may cover your doctor’s appointments and your private health fund may cover part/all of the costs for your medical cannabis.
WHAT CONDITIONS CAN MEDICAL CANNABIS BE APPROVED FOR?
The five main conditions that the Therapeutic Goods Administration (TGA) approves the use of medical cannabis are:
· Epilepsy
· Pain
· Multiple Sclerosis
· Nausea and Vomiting
· Palliative Care
Other common conditions where medical cannabis may be prescribed include, but are not limited to:
· Anxiety
· Depression
· PTSD
· Schizophrenia
· Irritable Bowel Diseases
· Endometriosis
· Fibromyalgia
· Arthritis
· Temporomandibular Joint Syndrome
· Radiculopathy
· Anorexia/Cachexia
· Cancer and Non-Cancer Chronic Pain
· HIV/AIDS
· Sleep Disorders
IN AUSTRALIA, MEDICAL CANNABIS LAWS VARY FROM STATE TO STATE AND CHANGE ALL THE TIME…
VICTORIA: Any doctor in Victoria can prescribe medical cannabis for any patient with any condition if they have the required Commonwealth and/or State approvals.
NEW SOUTH WALES: In NSW any doctor can legally prescribe a cannabis medicine for a health condition if they believe it is an appropriate treatment option for their patient, and they have obtained the relevant authorities from the Therapeutic Goods Administration (TGA). Approval will be based on the severity of your condition and the type of medical condition it will be treating.
QUEENSLAND: Any registered medical practitioner in Queensland can prescribe medical cannabis for any patient with any condition if they believe it is clinically appropriate and has obtained the required Commonwealth approval.
SOUTH AUSTRALIA: Medical practitioners can legally prescribe medical cannabis products subject to both Commonwealth and State regulatory requirements.
TASMANIA: Accessing medical cannabis prescriptions in Tasmania is slightly different from the rest of the country. Your local GP cannot prescribe your medical cannabis directly, so you must be referred by your medical practitioner to a specialist doctor. In Tasmania, medical cannabis applications are approved based on the patient’s condition, medical history, and proof they have adequately trialled other avenues of conventional treatments. For TGA approval, the application must provide some scientific evidence substantiating the medical cannabis prescription for your condition or symptoms.
WESTERN AUSTRALIA: Any doctor in Western Australia can prescribe medical cannabis if they believe the treatment is appropriate.
AUSTRALIAN CAPITAL TERRITORY: In the ACT, prescribers must have approval from the ACT Chief Health Officer and from the TGA to prescribe medical cannabis.
NORTHERN TERRITORY: A patient living in the Northern Territory must access medicines containing cannabinoids through an Australian doctor who is authorised under the Special Access or Authorised Prescriber Scheme administered by the Therapeutic Goods Administration.
GOVERNMENT FUNDING FOR MEDICAL CANNABIS
Medical cannabis still costs so much for patients because there is limited financial assistance from the government. While the price of medical cannabis products has reduced over the past few years, many patients still report that the ongoing cost of being a patient makes legal cannabis a short-term solution. Unfortunately, like many other aspects of cannabis, the customer service teams at Australian Health Funds lack an understanding of the availability. If you’re a Veteran, you may want to look into Defence Health and review the DVA funding for medical cannabis.
There is a charity called www.HelpTheHelpers.com.au which helps sponsor veterans, low income families and pensioners if they’re unable to afford a medical cannabis prescription. More information about how to apply for sponsorship can be found on the Help The Helpers website.
IS MEDICAL CANNABIS COVERED BY THE PBS?
No! Medical cannabis is an unapproved medication in Australia. This means that it is not listed on the Australian Register of Therapeutic Goods (ARTG) because as yet, there is insufficient clinical research to meet the eligibility requirements for listing.
DOES MEDICARE COVER MEDICAL CANNABIS?
If your GP is your medical cannabis prescriber, and your GP only charges you for your appointment, then the answer is yes, Medicare will cover your medical cannabis doctor’s appointments. If you attend a cannabis clinic it’s possible Medicare will cover a portion of your appointment. Medicare does not cover your medication costs.
HOW YOUR MEDICAL INSURANCE COVER WORKS FOR MEDICAL CANNABIS
When you have “Extras” medical cover all Australian insurers state that you have to pay the PBS co-payment which in 2021 is $41 per script and then the insurer will cover part or all of the balance of your prescription fee. You will need to talk to your insurer about medical cannabis cover and provide:
· Proof of your TGA approval
· A letter from your doctor
· A pharmacy receipt proving the PBS didn’t cover your medication
In some cases, you will need to talk to several people before getting a yes or no, so it’s important you get something in writing from your insurer so that you know exactly what you are covered for. If you phone your provider and they tell you that you are not covered, ask to speak to a supervisor or manager. Many customer service representatives are still unaware regarding the status of legal medical cannabis. Here is some helpful advice to present to your provider:
· Medical cannabis is covered under most private health funds’ non-PBS pharmacy, pharmacy, or non-PBS pharmaceutical categories.
· Even though medical cannabis is not on the ARTG, for you to get a script, the TGA approves your prescription either via the SAS program or the AP program. (If you are getting a compounded product, you do not have TGA approval).
· If you are unsuccessful with your initial customer service representative, request they ask their claims team if they cover S4 or S8 medical cannabis products that the TGA approves via the SAS or AP programs.
THE 2021 LIST OF AUSTRALIAN PRIVATE HEALTH INSURERS WHO COVER LEGAL MEDICAL CANNABIS (subject to change)
The Extras and Benefits listed below are per person, not a family rate.
|
Insurer Name |
Covers |
Lowest Rate Extras |
Annual Limit |
Max Cover |
Plan Type** |
|
ACA Health Benefits Fund |
Y |
Ancillary Lite |
$250 |
$50 |
E |
|
AHM health insurance |
Y |
Lifestyles Extras |
$350 |
$50 |
E |
|
AIA Health Insurance |
Y |
Enhanced Extras |
TBD |
TBD |
H + E |
|
Australian Unity |
Y |
Basic Extras |
$100 |
100% |
E |
|
Bupa |
N |
NA |
NA |
NA |
NA |
|
CBHS Health Fund |
Y |
Essential Extras |
$200 |
$50 |
E |
|
CDH Benefits Fund |
N |
NA |
NA |
NA |
NA |
|
CUA Health |
Y |
Essential Extras |
$100 |
$25 |
H + E |
|
Defence Health |
Y |
Value Extras |
$900 |
$100 |
E |
|
Doctors’ Health Fund |
ARTG Only |
Only have one plan |
NA |
NA |
NA |
|
GMHBA |
Y |
Basic Extras |
$150 |
$21 |
E |
|
GU Health |
Y |
Budget 50 benefits |
$200 |
100% |
H + E |
|
HBF Insurance |
N |
NA |
NA |
NA |
NA |
|
HCF |
N |
NA |
NA |
NA |
NA |
|
Health Care Insurance |
N |
NA |
NA |
NA |
NA |
|
Health Insurance Fund of Australia |
Y |
Saver Options |
$350 |
$80 |
E |
|
Health Partners |
Y |
SA: Basic Extras |
$100 |
$20 |
E |
|
health.com.au |
Y |
Extras 50 |
$350 |
$50 |
E |
|
Latrobe Health Services |
Y |
Basic Extras |
$250 |
$22 |
E |
|
Medibank |
Y |
Healthy Start Extras |
$500 |
$21 |
E |
|
Mildura Health Fund |
Y |
Five Star Extras |
$300 |
$35 |
E |
|
Onemedifund |
Y |
Comprehensive Extras |
$500 |
$65 |
H + E |
|
Navy Health |
Y |
Budget Extras |
$200 |
$50 |
E |
|
NIB Health Insurance |
ARTG Only |
Young At Heart Extras |
$400 |
60% |
E |
|
Nurses & Midwives Health |
N |
NA |
NA |
NA |
NA |
|
Peoplecare Health Insurance |
Y |
Simple Extras |
$200 |
$50 |
E |
|
Phoenix Health Fund |
Y |
Kick Start Extras 50 |
200 |
50% |
|
|
Police Health |
Y |
Only one Extras plan |
$600 |
100% |
E |
|
Queensland Country Health Fund |
Y |
Young Extras |
$150 |
$45 |
E |
|
*Railway & Transport Health Fund |
Y |
Value Extras* |
$300 |
$35 |
E |
|
Reserve Bank Health Society |
Y |
Only one Extras plan |
$1,000 |
$100 |
E |
|
St.Lukes Health |
Y |
Super Extras |
$600 |
$70 |
E |
|
Teachers Health |
N |
NA |
NA |
NA |
NA |
|
* Transport Health |
Y |
Healthy Choices Extras |
$400 |
$50 |
E |
|
TUH Health Fund |
Y |
Basic Extras |
$250 |
$50 |
|
|
Westfund |
N |
NA |
NA |
NA |
NA |
*Medical cannabis scripts which are covered at the health fund’s discretion.
** E = extras only plans available | H + E = can only get extras with hospital plan
Source: honahlee
