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