Reimbursement Policy for Cannabis for Medical Purposes

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Issuing Authority

Director General, Policy and Research

Effective Date

October 17, 2019

Document ID

2461

Purpose General Authority Eligibility Policy Annex A References

Purpose

This policy provides direction on the reimbursement of cannabis for medical purposes.

General

Access to the use of cannabis for medical purposes has been mandated by Canada’s courts. Health Canada’s Cannabis Regulations specify the conditions for authorization and legal possession. Cannabis is not an approved therapeutic product in Canada.
There have been limited trials which seem to support the use of cannabis in limited circumstances as an option after standard interventions are contraindicated or have been tried and have been unsuccessful and/or have yielded unacceptable adverse effects. Veterans Affairs Canada has heard from Veterans and their advocates that they believe cannabis helps them with their health problems. This information must be balanced with scientific evidence, sound clinical practice, and with the primary concern of the Department - the health and general well-being of Veterans and their families.
Recognizing that the use of cannabis for medical purposes continues to be an emerging practice, Veterans Affairs Canada will continue to monitor developments in research, and medical practice and experience, and adjust the policy provisions as may be required.

Authority

Subject to the provisions of this policy, reimbursement may be authorized for eligible Veterans and other qualified individuals in accordance with section 4 of the Veterans Health Care Regulations.

Eligibility

Veterans entitled to a Veterans Affairs Canada Disability Pension, Disability Award, or Pain and Suffering Compensation are eligible for the cost of treatment for their disability benefits entitled condition (see Treatment for a Disability Benefits Entitled Condition Policy). Certain Veterans may also be eligible for the cost of treatment for non-entitled conditions to the extent the treatment is not available from the province/territory in which they reside (see Eligibility for Health Care Programs – Eligible Client Groups).

Policy

Veterans Affairs Canada may reimburse an eligible Veteran for the purchase of cannabis for medical purposes, when the health care practitioner’s (defined in Health Canada’s Cannabis Regulations as a medical practitioner or a nurse practitioner) authorization is in accordance with Health Canada’s Cannabis Regulations. The medical document completed by the health care practitioner indicates the amount of grams per day of dried cannabis.
The maximum daily Veterans Affairs Canada reimbursement limit is 3 grams per day of dried cannabis or the equivalent in fresh cannabis, edible cannabis, cannabis extracts (including cannabis oil) or cannabis topicals.
Requests for reimbursement for more than 3 grams of dried cannabis (or the equivalent in fresh cannabis, edible cannabis, cannabis extracts (including cannabis oil) or cannabis topicals) will require additional supporting information for consideration as set out in Annex A.
Veterans Affairs Canada will reimburse the Veteran based on a maximum rate per gram of cannabis, when authorized in its dried form or the equivalent in fresh cannabis, edible cannabis, cannabis extracts (including cannabis oil) or cannabis topicals.
Veterans Affairs Canada only reimburses the purchase of cannabis for medical purposes when the product is purchased from a federal licensed seller (with the exception of seeds and plants). Canada has established a regulated system of federal licensed sellers that ensures sellers are meeting standards for quality and safety. This standardization is an essential consideration when determining whether to reimburse Veterans for cannabis for medical purposes. The health and well-being of Veterans is best ensured through accessing cannabis produced by the federal licensed sellers authorized in accordance with Health Canada’s Cannabis Regulations.
Veterans Affairs Canada, requires the following documents to confirm the Veteran meets the requirements of Health Canada’s Cannabis Regulations for the purposes of determining entitlement for reimbursement:
1. copy of the medical document completed by the health care practitioner; and
2. copy of the completed and confirmed registration document issued by a federal licensed seller.
Veterans Affairs Canada will only accept authorization from one health care practitioner at a time. More than one authorization may be considered, but the authorizations must be from the same health care practitioner.
Eligible forms of cannabis include all forms that are authorized by Schedule 4 of Health Canada’s Cannabis Act for sale by federal licensed sellers (with the exception of seeds and plants).
Veterans Affairs Canada does not reimburse the purchase of cannabis for medical purposes when the Veteran purchases cannabis outside Canada. The legislative regime established by Health Canada for access to cannabis for medical purposes includes regulatory requirements for the safe production and distribution of cannabis, and for legal possession. Recognizing the complexity and variety of approaches internationally, the Department is not able to adequately ensure the same level of regulatory oversight for the safe production, authorization, distribution, and legalization of cannabis for medical purposes. The health and well-being of Canada’s Veterans is paramount, and the varied approaches to cannabis for medical purposes is of concern.
No fee is paid to the health care practitioner for the completion of the medical document since VAC considers it to be covered in insured service fees. However, if the Department requires the health practitioner to complete additional documentation, an administrative fee may be paid.
Veterans Affairs Canada may deny approval of reimbursement when federal licensed sellers are determined to be operating outside of the requirements of Health Canada’s Cannabis Act or Cannabis Regulations, the requirements of this policy, and/or any approved provider criteria established by the Department and agreed to by the federal licensed seller.
Reimbursement for the purchase of a vaporizer may be authorized for eligible Veterans up to the established frequency and dollar limit. The purchase must be pre-authorized, and prescribed by a health care practitioner. Veterans Affairs Canada may consider other “equipment” when the device is medically beneficial, subject to the provisions of the Medical Supplies policy.

Annex A

Exceptional Approval of More than 3 Grams

Reimbursement may be authorized for more than 3 grams of dried cannabis or equivalent when confirmation is received from the treating physician that the Veteran is palliative. In end of life situations, documentation is not required from a medical specialist.
Palliative care is defined in the Palliative Care policy. The policy also includes additional considerations for Veterans requiring end of life care.
When authorization of cannabis for medical purposes is for Amyotrophic Lateral Sclerosis (ALS), validation of the diagnosis from the attending physician will be required.
In all cases, other than the circumstances as noted above, requests for reimbursement of more than 3 grams of dried cannabis or equivalent must be accompanied by additional documentation from a medical specialist. The required documentation from the medical specialist must clearly state:
1. the medical rationale for the use of CMP for the Veteran’s condition(s);
2. the specific quantity over 3 grams per day being recommended;
3. a list of contraindications that were considered and confirmed absent; and
4. a list of alternative treatments that were tried and why ineffective or contraindicated.
When authorization of cannabis for medical purposes is for chronic pain, additional documentation will be required from a medical specialist in the area of the treatment of chronic pain.
When authorization of cannabis for medical purposes is for a psychiatric condition(s), additional documentation will be required from a psychiatrist.
When both chronic pain and a psychiatric condition are present, additional documentation will be required from either a medical specialist in the treatment of chronic pain or a psychiatrist.
For any other health conditions, additional documentation will be required from a medical specialist with expertise in the diagnosed condition, including but not limited to chemotherapy-induced nausea and vomiting, wasting syndrome, or loss of appetite in AIDS and cancer patients.