August 31, 2021
Dear Leader Schumer and Senators Booker and Wyden:
Thank you for your continuing leadership on cannabis de-scheduling legalization, as well as on the social justice and equity reforms that play such a critical role in cannabis policy. As you know, cannabis reform is not just about the legalization and thoughtful regulation of marijuana, it’s about principles of American federalism and ensuring that our laboratories of democracy have the opportunity to help shape how cannabis should be regulated in the fifty states. There are currently three dozen state medical marijuana programs serving more than 3,500,000 patients in the United States, rapidly providing treatment plans designed to displace opioid prescriptions, and we are writing to ask for your help in protecting them.
Creating a Pathway for Medicinal Marijuana
While we were elated with much of the draft language in the Cannabis Administration and Opportunity Act, we believe that the bill misses the mark in some key areas by ignoring existing state medical marijuana programs and by failing to recognize state-level advances in medical marijuana. Congress must specifically and intentionally create a path to retain the medical cannabis industry that is critical to patients suffering from chronic pain, cancer, PTSD, depression, and other debilitating conditions.
Since the first state medical marijuana law was enacted in California in 1996, state governments have continuously demonstrated their competency for regulating the emerging medicinal cannabis marketplace. These states have tailored their regulatory regimes to ensure that they balance public health and safety, administrative feasibility, and business operability. Today, increasing numbers of physicians and other qualified providers in states with legal medicinal cannabis programs routinely recommend cannabis for qualifying conditions. Those qualifying conditions are state-specific and can include chronic pain, cancer, PTSD, end-of-life care, depression, anxiety, and other debilitating diseases.
We must specifically and intentionally retain these state medical programs currently serving millions of patients—offering arguably one of the most viable alternatives to opioids. We must also provide states with ample time to create their own medicinal markets, to build on advances in existing medical programs, and to harmonize state regulatory programs across the country, as is practicable. This must all be done deliberately and will take time to develop and implement. This will require a transition period prior to a national marketplace and intentional lawmaking by Congress.
Insurance Coverage
As a first priority, Congress should intentionally and specifically permit coverage by private insurance companies in the Cannabis Administration and Opportunity Act. Cigna already allows reimbursement for CBD products. While this should flow naturally from de-scheduling, an intentional and specific provision by Congress authorizing this pathway would stave off private litigation risks and Executive Branch overreach through regulation. Congress should also specifically provide for the allowance of HAS/FSA funds to be used for medicinal cannabis. These tax-deductible contributions are already currently being used on alternative care, including acupuncture, aromatherapy, ayurvedic medicine, homeopathy, nutritional counseling, and unregulated traditional Chinese medicine. These provisions are not currently contemplated in the Act, and will take time to promulgate, coordinate, and ultimately administer. Additionally, the industry should be permitted to make substantiated structure/function claims, without premarket review, notwithstanding the fact that cannabis may already be an ingredient in some pharmaceutical drugs. This policy should also be codified in federal law, rather than being left to FDA rulemaking.
Insurance Reimbursements
A successful transition to federal regulation must also support a clear pathway for insurance reimbursement for medical cannabis. The NIH/NIDA is currently funding a number of efforts to document and enable the successful treatment of patients with pain with cannabinoids in order to reduce their use/overuse of opioids. However, due to the lack of insurance reimbursements, nearly all of these costs are being absorbed by patients. Some states have noticed the pharmacoeconomic advantage that cannabis treatments can provide over existing therapies in specific indications, and their Medicaid programs are evaluating reimbursement for these situations. In addition, many workers compensation programs nationwide are taking similar steps. We therefore request that Congress specifically provide for the allowance of insurance reimbursements for medical marijuana patients in the Cannabis Administration and Opportunity Act.
Research
Notwithstanding housing the best medical research institutions in the world, Cannabis research in the U.S. severely lags behind other nations. While convincing research on cannabis safety and therapeutic utility of medical cannabis products is being generated in Europe and Israel, federal prohibition in this country obstructs open research into the science of cannabis therapeutics for products that do not have an approved IND, despite millions of Americans currently buying and using medical cannabis routinely. The president has indicated that he would like to see more research, so let’s give it to him. Let’s unleash American scientists and doctors to evaluate and document the myriad benefits of cannabis. This research will take time to get right and we should get this done prior to unleashing interstate commerce.
The Act mandates the comptroller general to issue a report on the societal impact of cannabis legislation within two years after the enactment of this Act. Congress has also provided a mandate to HHS to issue a report related to the public health effects of cannabis with an end-date of 2025. And Congress mandated that the secretary of transportation collect data on highway safety. The research objectives in the bill are critical to protecting public health and safety and will take time to get right.
For the foregoing reasons, we request that Congress incorporate insurance coverage and reimbursements into legislation and allow for a transition period prior to unleashing interstate commerce and imports. This will support medicinal marijuana programs currently serving millions of patients at the state level, and will ensure that we complete research and implement national standards to protect public health and safety.
Sincerely,
The Board of Directors of the Coalition for Medical Marijuana–New Jersey, Inc. endorsed the above letter and became a signatory to it, but did not create the letter.