Six medical cannabis patients and Ultra Health Dispensaries have filed a class-action lawsuit against health insurance providers in the state of New Mexico. The lawsuit would require health insurance companies to cover the entire cost of medical cannabis due to its use to treat trauma spectrum disorders like post-traumatic stress disorder.
“Legislation was passed which very specifically says that any insurer who offers behavioral health care coverage in New Mexico shall offer it with no copay, co-insurance deductible, i.e. no co-share,” Ultra Health CEO Duke Rodriguez said.
The legislation in question is Senate Bill 317, passed on March 20, 2021, which established that any health insurance that offers behavioral health service coverage cannot impose any cost-sharing for these services. The definition of behavioral health services, as outlined within the bill, specifically includes all medications used in treatment. The plaintiffs believe medical cannabis is a medication like any other and should thus be covered by insurance.
“On one hand, we have Senate Bill 317. On the other hand, we have very strong legal (precedent) that (has) determined that medical cannabis in New Mexico is health care. Medical cannabis in New Mexico is even, at times, very comparable to medications,” Rodriguez said.
Jacob Candelaria, a New Mexico state senator and one of the six patients who are part of the lawsuit, said that any other pharmaceutical drug would not receive the same kind of scrutiny as medical cannabis has.
“Imagine if a new lab-created PTSD pharmaceutical came out that could cost tens of thousands in costs per-patient, per-month. Insurers would cover it. Cannabis should be the first line of defense before you move to very toxic or addictive narcotics,” Candelaria said.
Since the passage of the Lynn and Erin Compassionate Use Act in 2007, cannabis has been legal for medical use in the state. Other court cases have upheld the legitimacy of Cannabis as a medical prescription including Sacred Garden Inc. v. New Mexico Tax and Revenue Department, which ruled medical marijuana is exempt from gross receipts tax
Currently, 73,400 medical card holders use cannabis for PTSD treatment — the most of any primary qualifying condition, according to the New Mexico Department of Health.
Candelaria said that medical cannabis, which has been essential for treating his PTSD, currently costs him over $1,000 per month. However, he said he is in this fight not for himself, but for others who may never be able to afford what he pays.
“What I am most concerned about is folks who are not in my position, and the tens of thousands of people in this state who are struggling daily with a horrible behavioral health condition … and don't have the means (for treatment),” Candelaria said.
The need for litigation after the passage of Senate Bill 317 to see the bill take full effect did not surprise Candelaria in the slightest.
“Well, unfortunately, having been around Santa Fe for a decade, I did expect that some litigation would be necessary to get it done. And here we are,” Candelaria said.
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Insurance provider True Health New Mexico said they could not comment on the litigation. Cigna, Blue Cross Blue Shield of New Mexico, Molina Healthcare of New Mexico and Western Sky Community Care did not respond in time for publication. Presbyterian Health Plan and Presbyterian Insurance Co. said they would wait to comment further.
“Presbyterian Health Plan is committed to ensuring that New Mexicans can access the behavioral health services they need. We will reserve comment for the appropriate venue,” Melanie Mozes, Presbyterian Healthcare Service’s director of communications, wrote in a statement to the Daily Lobo.
The case could serve to set a new precedent in health insurance coverage not only in the state of New Mexico, but in the United States; Candelaria said providing coverage of medical cannabis to those who need it is just the right thing for insurers to do.
“We have very patiently waited for over a year hoping that the insurers would come to the reality that they have to do the right thing, and the right thing is to cover medical cannabis,” Candelaria said.
Madeline Pukite is the managing editor at the Daily Lobo. They can be contacted at email@example.com or on Twitter @maddogpukite.