Pubdate: Mon, 23 Mar 2015
Source: Toronto Star (CN ON)
Copyright: 2015 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Isabel Teotonio
Page: E7

PRIVATE INSURER AGREES TO PAY FOR MEDICAL MARIJUANA

Waterloo University student hopes victory clears the way for others
seeking coverage

After a hard-fought battle, Jonathan Zaid's medical marijuana is being
paid for by his private insurance company - a feat some industry
insiders say is unprecedented.

Now, the third-year University of Waterloo student, who suffers from a
rare illness called new daily persistent headache, is hoping his
victory clears the way for other patients seeking coverage for cannabis.

"I had to fight a lot of battles to get to where I am," says the
22-year-old Toronto native. "My persistence paid off in the end."

Last summer, Zaid submitted a claim for his medical marijuana to
insurance giant Sun Life Financial. It was denied. Insurance companies
don't typically pay for cannabis. Although medical marijuana is
federally regulated, it is not an approved medicine in Canada and has
no Drug Identification Number (DIN).

But Zaid wouldn't give up. He was frustrated with always asking his
parents for money to buy his "medicine" from a licensed producer. And
after trying 48 different drugs over the years, only marijuana eased
his chronic headaches. He figured it should be recognized as
prescription medication - after all, it was prescribed by a doctor.

Zaid, the son of a retired lawyer, presented research on his condition
and the medicinal benefits of marijuana to an oversight committee of
the University of Waterloo student union, which administers the
student health plan. It would be up to the student association as the
plan's sponsor - that's the organization or employer that sets up the
healthcare plan - to ask Sun Life to make an exception.

Student Ben Balfour, who is part of the committee, says there was
initial concern about approving Zaid's request because it was their
first time dealing with marijuana.

"We were testing the waters and we didn't know how people would
react," says Balfour, vice-president of operations and finance for the
Federation of Students.

But after much back and forth between Zaid and the committee, which
includes a physician, his request was approved in December. The
committee found Zaid's evidence to be persuasive, that the plan could
support the cost and that having Zaid's medicinal marijuana covered
would positively impact his academic success and well-being.

"It's really something new and I was very excited to be a part of it,"
says Balfour. "I'm just very glad that we were able to figure it all
out in the end."

Sun Life issued a cheque reimbursing Zaid for nearly $3,000, covering
the costs of cannabis and a $750 vaporizer - he gave the money to his
parents. His triumph doesn't mean other U of W students are
automatically covered for medicinal marijuana, which has not been
added to the formulary. But, it opens the door for others to follow
his lead and go through the same process.

Sun Life can't comment on the specifics of this case or benefit plan.
While medical marijuana is not an eligible expense in its standard
benefit plans, it does consider requests for exceptions if directed by
the organization or employer responsible for the benefit plan.
Insurance behemoth Manulife has a similar policy, but is not aware of
having made any exception for medical cannabis.

There are cases of the government paying for medical marijuana:
Ontario's Workplace Safety and Insurance Board, Quebec's Commission de
la sante et de la securite du travail and Veterans Affairs, via

Medavie Blue Cross, have covered cannabis costs.

It's unclear how unusual Zaid's case is because Sun Life will not
comment on if other patients, or benefit plans, have requested similar
coverage.

And, it's unknown what effect, if any, it will have on future claims
for cannabis made to insurers, says Wendy Hope, vice-president of
external relations for the Canadian Life and Health Insurance
Association. Hope says this sort of claim is not unprecedented and
that, for some time now, some private insurers have been reimbursing
costs for medical marijuana through health spending accounts -
although it is rare.

Zaid attributes his success to not giving up, but realizes few
patients have the strength, or know-how, to accomplish what he did.

"We're talking about very sick people and lots of them don't have the
resources to spend in order to fight for fair access," says Zaid.

His advocacy work prompted him to launch the non-profit Canadians for
Fair Access to Medical Marijuana and he now sits on the patient
advisory board of licensed producer Bedrocan Canada. Sarah Smith, who
pays $180 a month out-of-pocket for medical cannabis after being
denied by her private insurer, hopes Zaid's case will impact insurance
practices. Unlike Zaid, she says, "I didn't have the fight in me."

"I'm optimistic this will help open the eyes of insurance companies
that not all prescriptions are pills, sometimes it's an herb," says
Smith, not her real name. "They shouldn't be differentiating - a
prescription is a prescription."

Zaid's case is precedent-setting, says Marc Wayne, CEO of Bedrocan
Canada and chair of the Canadian Medical Cannabis Industry
Association.

"It's an example of the way this type of thing has to work Insurance
companies aren't going to come out and say, 'We're going to cover
medicinal cannabis for everybody.' It's a case-by-case approach and
hopefully it will reach a tipping point."
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MAP posted-by: Matt