A New Mexico medical cannabis provider that runs 25-plus dispensaries in the state is seeking confirmation from insurance providers and state officials that cannabis will be covered as a behavior health service.

New Mexico Top Organics-Ultra Health, the provider, recently sent a letter to several of the state’s prominent health insurance companies, asking them to affirm they’ll be making payments for medical cannabis.

Ultra Health is a vertically integrated and minority-owned company with expansion plans to have a total of 35 store locations in the state by the end of the first quarter of 2022.

The letter also requested information from the insurers in regard to how they intend to pay for medical cannabis without any cost sharing for patients enrolled through their programs. It was sent to representatives from Presbyterian Healthcare Services, Blue Cross Blue Shield of New Mexico, Western Sky Community Care, Molina Healthcare of New Mexico, Office of the Superintendent of Insurance, New Mexico Federation of Labor, and the New Mexico State Personnel Office.

“Ultra Health acknowledges that the idea of health insurers paying for medical cannabis may seem novel at first blush,” the six-page letter states. “However, as Ultra Health will discuss below, it is actually a rational, reasonable notion when considered in light of other New Mexico law. New Mexico already requires workers compensation insurers to pay for medical cannabis, and New Mexico already treats medical cannabis the same as conventional prescription medications. The fact that health insurers should—and will—pay for medical cannabis is not revolutionary at this point. It is the next logical step, and it is a small step, not a giant leap.”

Ultra Health claims to have New Mexico law on its side through Senate Bill 317, legislation that expanded the definition of behavior health services to cover several treatment options. Becoming effective on Jan. 1, 2022, the legislation intends to make mental and behavioral health services more affordable for New Mexicans by eliminating all cost-sharing and any out-of-pocket costs for those services and accompanying medications.

Under S.B. 317, insurers that offer coverage of behavioral health services cannot impose cost sharing on “professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including … all medications.”

Ultra Health is putting added emphasis on the “all medications” wording as it pertains to cannabis under the state’s medical program.

In New Mexico, cannabis is an approved medicine for several qualifying conditions, such as post-traumatic stress disorder, opioid use disorder, severe anorexia and Parkinson’s disease, which are considered behavioral health disorders under the Lynn and Erin Compassionate Use Act.

Among the roughly 130,000 New Mexicans enrolled in the state’s medical cannabis program, as of January 2021, about 73,000 qualify for cannabis treatment under behavioral health diagnoses, according to Ultra Health. More than 71,000 of enrollees have PTSD as their qualifying condition, according to the New Mexico Department of Health.

Ultra Health acknowledged that insurers may need to segregate federal funds from the funding they use for medical cannabis, since cannabis remains federally illegal. Ultra Health also addressed the belief that cannabis dispensaries may be “disorganized operations” that could never be integrated with insurance payors.

“Such beliefs would be easily dispelled by becoming acquainted with the modern medical cannabis dispensary system,” the six-page letter states. “Modern New Mexico dispensaries are bright, welcoming places located next to barbershops and banks. Many managers and executives in New Mexico’s medical cannabis system have actually worked in traditional health care systems and have familiarity with insurer practices.”

The letter adds, “New Mexico has a robust licensing scheme that can ensure that insurers only pay for cannabis sold by licensed entities. New Mexico also mandates that medical cannabis purveyors use a tracking database called BioTrack, which means that the amount of cannabis sold can be accurately reported to payors.”

Ultra Health suggests that the best approach for insurers would be to treat medical cannabis dispensaries like pharmacies: the patient comes in, obtains the cannabis, and then the dispensary requests payment from the insurer.

The company also suggests that a direct patient reimbursement model—where patients pay and then seek reimbursement from their insurance providers—would be difficult in the cash-intensive industry.

]]>