Health Affairs has an interesting paper that looks at Medicaid pharmacy spending differentials depending on state medical marijuana laws. It has an interesting finding:
We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion
There are two caveats with this estimate. The first is not every state has a medical marijuana law although the number of states with this type of law is increasing. Secondly, Medicaid Fee for Service is a shrinking means of service delivery. More and more states are moving more of their Medicaid population and spending to Medicaid managed care organizations. Managed care increases the impact of the laws diverting prescription drug. A realistic all sources Medicaid estimate is at least double if not triple the fee for service estimate on my back of the envelope guess.
This is interesting as hell. I wonder how full legalization and decriminalization efforts change state spending on prescription drugs as those steps dramatically lower the retail cost of marijuana compared to the medicalization schemas.
More importantly, how does this work in a world of Medicaid 1115 waivers where the states want to test Medicaid beneficiaries for illegal drug use? Are they just testing for everything but marijuana? Are they testing for everything, sending people who ping positive for weed to expensive treatment and costing their Medicaid systems significantly more money due to both treatment and increased pharmacy costs?
How does this work? And should we as a society encourage medication substitution with medicalized marijuana?
I have no good answers for that.
**Bradford, A. C., & Bradford, W. D. (2017). Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees. Health Affairs. doi:10.1377/hlthaff.2016.1135
manyakitty
How does that drug testing work? Can the member get a waiver for an authorized rx under a doctor’s supervision?
Ohio Mom
Off topic but I received yet another email today from a local disability group, announcing a workshop that responds to the expected continual cuts in government funding support.
Last week it was a workshop on life planning for family members with disabilities: all do-it-yourself, don’t assume there will be a Medicaid Waiver to pay for living expenses, better round up your relatives and neighbors to provide the needed continual supports.
This morning it is a housing group that is planning a development with a mix of market-rate and affordable units, occupied by a mix of disabled and non-disabled residents, as a way of providing housing (and day-to-day supports) without government support.
These are all interesting ideas and I appreciate the grassroots aspects. They are good and important efforts.
But the passive acceptance of the idea that Medicaid cuts are inevitable, that is some sort of unstoppable force like the tides or days shortening every fall, enrages me.
The leadership of the local disability community thinks I’m a nut by the way, for having even suggested that they organize an effort against the block-granting of Medicaid that was to be a part of the ACA “replacement.” I was told that we have to accept that “people feel differently” (i.e., there are Republicans among us). Imagine saying something along those lines in the Civil Rights era, We shouldn’t organize and protest because not everyone will agree with us.
This comment is mostly me talking to myself, trying to organize my thoughts. Thanks to all for the opportunity to do so.
weaselone
Well, given that the purpose of drug testing is largely to shame poor people and shuffle money from poor people who need it to drug testing companies, it basically works the same as it does now. Anyone who isn’t legally using marijuana with a doctor’s prescription loses benefits unless the state government or voters through a ballot initiative carve marijuana use out as an exception. In the case that the Feds ultimately dictate loss of benefits for drug use, they lose benefits unless the state gives the Feds the middle finger, accepts whatever sticks/rejects whatever carrots the Feds are using and funds the benefits themselves.
laura
In my job, we have to read flyers with brief articles on labor relations, changes to state and federal employment laws and case notes. These are published by management-side law firms.
Recently, a brief article referenced a work-related injury and treatment. The injured worker had better pain relief after substituting medical mj for the opioid pain reliever. The dispute involved whether the employer benefit plan had an obligation to cover the cost of the medical mj, or could the plan limit the offering to the less efficacious opioid. The court found that the employer’s plan is required to cover the cost of the medical mj.
To me, this is a clear sign of a sea change, though likely to face a lot of unnecessary litigation, especially at the federal level. If u can track down the article or citation, I’ll add it to the post if anyone is interested.
Barbara
There are a lot of variables here, probably too many. Just a few examples of variables that might be at work: states with medical marijuana have higher utilization of generic drugs (undoubtedly this is true in California), they have populations that are less likely to turn to prescription drugs irrespective of the individual’s marijuana use (e.g., the kind of people that would rather try melatonin before resorting to a prescription sleeping aid).
However, this is the kind of result that would normally be used to design more targeted studies, such as, looking at the utilization patterns of specific kinds of drugs in states where medical marijuana is being used. That is, is overall utilization down or is the utilization prevalent among certain classes of drugs, such as pain relief or sleeping aids? That in turn, could lead to studies about the effectiveness of marijuana versus other kinds of drugs for given conditions. That is, it would if the DEA were a sane agency. Even under Democratic presidents, that’s an unlikely development.
Miss Bianca
I live in CO, which is a medical mj as well as recreational mj state. I’m not actually sure what our company policy is for mmj use – I work for a hardware store that is independently owned, but part of a large chain – and last year we switched to a “random drug test policy” – because of insurance costs, I was told. Now, what the company would do with a mmj user I don’t know – if you already had your prescription, would the company refuse to hire you? If you got a prescription while working for the company, would they fire you? Would either of these actions be legal? I don’t know – but I’m sort of tempted to find out on my way out the door. ; ) (Full disclosure: I have found cannabis to be efficacious for treating my back pain and also depression. I have resisted getting a mmj card mostly because I don’t want to be in someone’s system when the feds decide to come knocking. I am also going to be applying for a liquor license for my mead-making, so probably no mmj card in the future unless and until federal laws change. But I hope to hell federal laws do change sometime within my lifetime, because the War on (Some) Drugs seems particularly nonsensical when waged against a plant).
StringOnAStick
I find mmj helps with pain and depression, plus grief. I got an mmj card over a year ago because I was sure HRC would win and a lot of this crazy would go away; bad bet on my part apparently. Now I just wonder when it is going to hit the fan and the fall out puts me out of a job. The workers and owners at the dispensaries seem so blase to me, saying Drumpf is a businessman and wouldn’t kill such a thriving industry, or that the state will go to bat for it because of the huge amount of taxes it generates. Seems, ah, overly optimistic.
Barbara
@Miss Bianca: One of the core issues with marijuana testing is that, at least so far, assays that test for marijuana are not sufficiently time or concentration specific to determine whether someone is “under the influence” at the time of the test, or what concentration or volume of marijuana they have consumed. The concentration might not matter as much as it does with alcohol, which is clearly a dose specific substance. In my experience, people don’t consume more and more marijuana to get higher and higher, at least not the same way they do with alcohol. There are also issues with false positives from passive exposure.
Saving Private Equity
A related question is what about the supplier side? For those that have, or are thinking about having, a wholesale business supplying this market, the risks are high. The need is real, the market exists, but the feds could kill both the free market and the customers at a moments notice.
Miss Bianca
@Barbara: Fascinating. (Imagine that in my best Spock voice, also the raised eyebrow).
But then, you are always a fount of fascinating information!
cmorenc
@Barbara:
However, the criteria with drug-testing for benefits isn’t whether the subject is high at the time of testing, but whether the test indicates the subject has detectably used the drug within the far longer period when the relevant metabolites are still detectable. Depending on frequency of use, this can (for urine-based tests) be as short as 72 hours later, or as long as 12 weeks later before the residual amount falls below the test threshold..
Origuy
If you use medical marijuana, you may be taken off of transplant lists. CNN (beware autoplay video)
cmorenc
@Saving Private Equity:
I’ve been pleasantly surprised that AG Sessions hasn’t already initiated a legal jihad against states which have legalized recreational (and perhaps even states that have legalized just medical mj). Of course, Sessions could any day disappoint us by doing just that – but query whether his own political calculus (and that of others in the Trump Administration’s inner circle) have concluded that even as vengeance against the mostly blue states that have legalized recreational mj so far, there is more risk than gain in taking this on, at least for awhile. Perhaps they realize lots of GOP-leaning glibertarians and supporters are stoners, and it’s not just hippies any more?
neldob
I thought it said “Medical marijuana, Medicaid and Drug Testing Retirees”. Seeing as there’s talk of “fixing” Medicare that may be prescient.
Barbara
@cmorenc: Whatever the purpose of the testing, the testing for marijuana is too imprecise to make specific findings. And the mode of action of marijuana on pain management or depression is unclear. This is not a criticism of marijuana, it is further evidence that the DEA has created a vacuum into which many people feel unconstrained by data in making unsubstantiated claims about the benefits and risks of using marijuana generally and for medicinal purposes.
cervantes
Uhh, David, this is embargoed until May 1, in case you didn’t notice. They could well take you off their list. Just sayin’.