CBD Oil: An Update

Regular readers may recall our post from last month on insurance and CBD oil:

"I had an interesting conversation with a doc who specializes in pain management and is a big fan of CBD oil and its pain-reducing abilities. He also claimed that taken topically (ointment) or even orally, one would likely not get flagged on a drug test."

Well, I recently received this in email from one of my group clients:

"Hi Hank!

Brought to my attention and I didn't know:

CBD oil/salves for anxiety/depression/pain management?

Has anyone asked you about these for HSA write offs?"

Which is a great question.

I did some research, and thought I'd found the answer:

"CBD products are probably not considered HSA- or FSA-eligible, though there hasn't been any formal guidance from the IRS on the matter. This is similar to medical marijuana, which is also not HSA or FSA-eligible even if you're taking it for a diagnosed disorder or to reduce the effects of chemotherapy"

But just in case, I also reached out to our own gurus of all things HSA/FSA/HRA. Their answer surprised me:

"Although we have received no official guidance, it’s seem reasonable that with the passing of the 2018 Farm Bill it can be reimbursed through FSA and HSA’s with a doctor’s note prescribing it for a specific diagnosis."

So there you have it: the key is in that little script fom the doc.

Sweet!

Don't Bogart That Ointment

So I recently had a life case go south in a weird way:

Did my usual pre-screen, which includes height, weight, any meds, any tobacco use, and the like; based on his answers (including no tobacco use), gentleman seemed to qualify for a preferred non-smoker rate. And so we submitted the application and arranged for the paramed exam. All very cut-and-dry.

Until I got back the approval .... at Preferred Smoker class.

Hunh?

So I thought "oh, he vapes or maybe had a cigar the day before." But when I called, he said no, had quit smoking years ago, but when he gets anxious he sometimes pops some nicotine gum.

Hunh.

So I called the underwriter, who said, based on the lab result, my guy's "popping that gum" a lot; enough, in fact, to kick him into tobacco use territory.

But Henry, you object, he's not using tobacco, he's just chewing some nicotine-laced gum.

Um:

"Nicotiana tabacum, the type of nicotine found in tobacco plants."

Oh.

Thing is, most folks don't make that connection: they (reasonably) believe that nicotine ≠ tobacco, because they're not smoking or chawin' it.

Which brings me forward a few weeks, to CBD oil:

"Cannabidiol (CBD) is one of more than 100 unique “cannabinoid” compounds that are found in the oily resin of the cannabis plant ... To make CBD oil, one must start with CBD-rich plant material."

Are you beginning to see a connection?

This past weekend, I had an interesting conversation with a doc who specializes in pain management and is a big fan of CBD oil and its pain-reducing abilities. He also claimed that taken topically (ointment) or even orally, one would likely not get flagged on a drug test.

I questioned this, in part because of my client's recent tobacco/nicotine experience. One of the questions on life applications is about marijuana (among other drugs) and/or extracts thereof. So I again reached out to my primary carrier's underwriter to see what he had to say, and he graciously replied:

"If the applicant is taking CBD oil, it should be noted on the application as we ask if they are taking any medication, prescribed or not. The drug testing results should be negative if they are using CDB oil.

Our concern certainly is if they have chronic pain and we would rate for this impairment."

Which, to be fair, I hadn't even considered. So it turns out that my doc friend was right about red flags for the oil itself, but the underlying impetus for its use would be a concern. And, of course, it is a med, so needs to be noted on the application.

Interesting (at least to geeky me).

[Thanks to FoIB Rob P for the assist]

Darn those Boomers....

And their Wacky Tobacky! Via email this morning from Mutual of Omaha:

"MutualCare Solutions underwriting guidelines for marijuana use has changed.  Effective 10/1/18 we will consider occasional recreational use."

So I must admit, when I first read this, I thought "what the ... college kids aren't buying Long Term Care insurance!" And then it hit me: it's not Joe College, it's Ned and Nancy Boomer, taking tokes at Bridge Club.

Wow.

Potential Good News

Our friend Jeff M tips us that Gem State citizens may soon have the option of buying non-ACA compliant plans:

"Idaho says no Obamacare needed for some new insurance plans ... on Wednesday revealed a plan that will allow insurance companies to sell cheap policies that ditch key provisions of the Affordable Care Act."

While this is indeed good news (because it means that at least some lawmakers "get it"), it's a far cry from a done deal:

First, as folks in medical-marijuana states have come to learn, Feds trump states. So, any such plans are going to be subject to the ObamaTax (at least for now). Which isn't necessarily an insurmountable impediment, but something to keep in mind.

Second, which carrier's going to put in the time, manpower and - critically - money to develop and price a plan available in only one state (and the 39th in terms of population, at that)? In general, insurance companies are reluctant "first adopters."

On the other hand, if this actually happens, it would represent the first effective argument I've seen for "sales across state lines."

Finally.

Some Quit Hits

■ Medical marijuana and your health insurance:

"It is our job to responsibly manage around $6 billion of our members’ and employers’ money ... How on earth could we involve them in this chaos by covering marijuana, medical or otherwise, at this point?"

Great points.

■ We've been following the Penn Treaty LTCi kerflufle for a long time (here, for example). What's the latest?

Well:

"Connecticut OKs 69% Penn Treaty Unit LTCI Rate Hike"

That's a big deal for the folks who own one of the 500 or so policies still in-force in the Constitution State.

■ A thousand words (or so) from FoIB Rich W:

Its working! The ACA is working!! And better than expected.

Health Insurance Premiums Rising as High as 265 in Virginia This Year https://t.co/llaWD6eYfs #NewsandPolitics via @pjmedia_com

— Rich Weinstein (@phillyrich1) January 2, 2018

Health Wonk Review: Puppies and Kittens edition

After a contentious election season, where my preferred candidate didn't even show up, I thought it'd be nice to focus on something a bit more pleasant. And nothing quite brings the smiles like pics of our little furry friends [ed: bonus points to anyone able to guess the significance of the first one].

And so, without further ado, this week's hectic, eclectic, fur-bally HWR:

■ HWR co-founder Joe Paduda  offers the first two entries in his new series The Flash vs Spiderman "Getting Serious About Health Reform" (Part 1 here, Part 2  here), wherein he offers his own suggestions about where we go from here. As usual, interesting stuff.

■ One of our favorite wonks, David Harlow is actually traveling quite a bit lately, most recently to an innovation in healthcare convo in The Big Apple. He graciously took time out to send in his take on how the election will likely affect not only the ACA, but what the various pols are likely to propose.

■ It's been a while since Adam Fein's participated in the HWR, but he's back and in fine form with this post on "The 2025 Payer Market for Prescription Drugs" (wait, Adam's the new Dr Who?). 
 

■ The Health Affairs blog's Karen DeSalvo and Georges Benjamin offer their thoughts on what the future of public health will (should?) look like, including how to compete in a global economy.

■ Our good friend David Williams sends in this post on  legalizing marijuana, both for recreational and medicinal purposes. Considering how well pot-related ballot issues did this year, it's likely to be a hot topic for a while. In his post, David interviews a "marijuana entrepreneur" about implementation.

■ Another HWR favorite, Louise Norris, looks past the election results to dispel some misinformation currently making the rounds: she thinks it's likely that the mandate/tax will still be in force for 2017, and explores what that means to thee and me.

■  Uber-wonk Roy Poses submits his take on the "Bio Telemetry Settlement" (see, I told you he's an uber-wonk 😊), wherein he continues his long-standing exploration of ethics (and/or the lack thereof) in healthcare, this time specifically about physician kickbacks and medical devices.

[ed: And pay special attention to the sidebar pic for that post]

■ Dr Jaan Siderov, still another long-time 'Review regular, takes a respectful (and insightful) look at the potential winners and losers in the upcoming ACA battles, focusing specifically on "organized medicine" and mHealth.

■ Our very favorite Healthcare Economist, Jason Shafrin, talks about "Precision Medicine" and how it potentially offers both vast benefits for patients and challenges for providers (and government regulators).

■ Peggy Salvatore waxes philosophical about the "Healthcare Industry in an Age of Uncertainty;" her concern about special interests is quite thoughtful, especially when we really don't know how things will ultimately shake out.

■ Our dear friend Julie Ferguson asks "what's in store for OSHA and the Department of Labor under the new administration?" Reading the tea leaves in her crystal ball [ed: heh], she takes the President-elect at his word about the ACA being on the chopping block, and what that may portend for OSHA and worker's comp.

■ Our own post explores the changing landscape of specialty prescription meds, specifically the effect of   manufacturers' coupons on claims and balances.

And please tune in again on the 15th, when Julie Ferguson works her own Health Wonk Review magic.

Life Insurance in the Weeds

Over at LifeHealthPro, Ben Steverman has an interesting article about the challenges facing folks involved in the (medical?) marijuana trade, which is now legal in a handful of states. Even though these folks may have never even used their product, they're apparently having a hard time securing the coverage they need to protect their families in the event of the untimely demise.

Derek Peterson, for example, is "the chief executive officer of Terra Tech, a publicly traded pot company based in Irvine, CA." When he recently applied for life insurance coverage with Mutual of Omaha, the underwriter put the kibosh on his plans, stating that:

"We have discontinued the processing of your application for insurance due to company policy. We cannot accept premium from individuals or entities who are associated with the marijuana industry."

Okay, they're certainly within their rights to set underwriting guidelines, but this seems perhaps a bit heavy handed. It's not stated, but we can infer from the article that he wasn't actively using marijuana, merely involved in its production and distribution.

[ed: You'll notice that I didn't say "legal" production and distribution. We'll circle back to that momentarily]

The article quotes  Loretta Worters, spokesperson for the Insurance Information Institute, who observes that "[t]he problem from a life insurance underwriter’s point of view is that, unlike tobacco, there isn’t a lot of data available to assess the risks of coverage for marijuana users"

But this begs the question, since there's no indication that Mr Peterson used pot, either in the past or currently.

So I reached out to some of my own sources; one, a life insurance underwriter, told me that "I personally have not had to underwrite a client who was a pot store owner, but it would be a situation where it would be case by case review.  I think the article hit the nail on the head when she stated that there isn’t a lot of data available to assess the risks of coverage."

She pointed out that there are other industries that carriers tend to "underwrite a little more carefully- people who own bars, gun shops…..  and that again is just because of the statistics and mortality studies that we have that these people have increased incidents of alcoholism, bar fights, being robbed at gun point."

Which makes a lot of sense, but I still had my reservations.

Until I heard from a good friend who's also the field rep for one of our carriers, who I think really pegged it:

"While pot may be legal in certain states, it's still a Federal offense, and we tend to shy away from folks that are actively - and publicly - committing felonies."

Makes sense, no? Simple, straightforward, and cuts right to the chase.

Top O'The Week Linkfest

■ LifeHealthPro's AllisonBell has some disheartening news about critical illness plans:

"Officials are ... thinking about the possibility of banning the sale of critical illness policies and other policies that cover two or more specific diseases"

The Bureauweenies in DC© see these plans as some kind fo threat to ObamaPlans, as if they were an alternative when in fact they are useful supplements.

■ FoIB Holly R reminds us that even pot-smokers need life insurance, but what effect will marijuana use have when they apply for a policy? As always, this will depend on the carrier, but some companies are more, um, liberal than others when it comes to Mary Jane:

"29 percent classify marijuana users as nonsmokers, potentially allowing them to qualify for the best nonsmoker rates:"

Sweet.

■ Last we looked, so-called "Junior Doctors" working for the Not So Vaunted National Health Service© had called for a major work slowdown. So how'd that work out?

Oh:

"The NHS is paying junior doctors to learn how to land lucrative new jobs outside medicine"

Fewer doctors, better health care.

Got it.

Don't Bogart that Policy, Bro

Here's something you don't see every day:

"Marijuana users, who can now buy weed without fear of arrest in some U.S. states, can also get life insurance without facing a smoker penalty — if they shop carefully."

Apparently, some carriers are more lax regarding casual pot use than others. I know that we've seen a slight lifting of restrictions on occasional cigar smokers, so one supposes that this is just an organic outgrowth of that policy (SWIDT?). According to Munich Re (a major reinsurer), some 80% of life insurers have some kind of marijuana-use policy in place, and about a third of these classify such folks as non-smokers (presuming, of course, that there's no actual tobacco use).

This could save insureds significant premium dollars, so it's worth checking out if you use (or plan to use) the ganja.

Cavalcade of Risk #200(!): Community Gratitude edition

Jeff Root hosts this week's milestone Cav, with another eclectic and interesting collection of risk-related posts. Come for the alarming news on first-day-on-the-job deaths, and stay for risks of marijuana laws.

And here's to the next 200 Cav's!

PS: We're still looking for Spring-time hosts - just drop us a line to sign up.

No Right to Pot

Pssst. Want some weed?     

Don't go to Montana. The government says you have a right to be sick but you do not have a right to treatment, at least when it comes to medical marijuana.

State restrictions on medical marijuana access and sales do not violate patients’ rights to pursue health care under the state constitution, the Montana Supreme Court has ruled. The decision overturns a lower court opinion that had blocked new regulations on the state’s voter-approved medical marijuana law.

The restrictions limit medical marijuana dispensers to three patients each and prevent them from making a profit. The limitations essentially gut the original law and make it difficult for patients to obtain medical cannabis, said Elizabeth Pincolini, a board member of the Montana Cannabis Industry Assn., a plaintiff in the lawsuit.

Amednews, Patients have no right to medical marijuana.

What will they do next? Say you can't buy a 32 ounce sugary drink?

And they want to prevent the dispensers from making a profit. Sounds a lot like income redistribution.

The rewrite of the original statute “was designed to make it as hard and painful as possible to participate in this program,” she said. “It’s bad news for patients. Everyone has to grow their own [cannabis] or find a provider to provide medicine for free.”

Grow your own? Some of us have a brown thumb.

Bummer.

No-High Weed

From time to time, we've written about medical marijuana. One of the potential arguments against its use is that simply saying "it's for medicinal purposes" seems somewhat disingenuous.

Now comes word of a pot breakthrough:

"Israeli scientists have cultivated a cannabis plant that doesn't get people stoned in a development that may help those smoking marijuana for medical purposes ... the new cannabis looks, smells and even tastes the same, but does not induce any of the feelings normally associated with smoking marijuana"

Interesting development.

Miracle Weed

A while back, Bob pondered whether or not medical marijuana would be a covered expense under ObamaCare©. Well, we're still waiting on that one, but at least one unlikely player has stepped forward to offer assistance to, um, "providers:"

"Scotts Miracle-Gro Co. [see note] has long sold weed killer. Now, it's hoping to help people grow killer weed ... Scotts Chief Executive Jim Hagedorn said he is exploring targeting medical marijuana as well as other niches to help boost sales at his lawn and garden company."

[ed: Formerly Stern's Miracle Gro. Just sayin'.]

Turns out, 16 of the 58 states "have legalized medical marijuana ... The market will reach $1.7 billion in sales this year."

That's a lot of extra pizzas and Doritos.

One wonders if Scott's is bucking for an ObamaWaiver©.

Grow Up

Obamacrap made it possible for children to stay on their parents plan until age 26. This is past the age when they can legally drive, vote and drink adult beverages.

So why does DC still consider them children?

CNNMoney has this comment.

The government had hoped that extending the age for dependent coverage to 26 would drastically reduce the large number of young adults who do not have any health care coverage.

But the survey's results show that parents, already facing higher costs to cover their families, are put off by the additional costs of taking advantage of the new provision.

Well why didn't Washington just make it a REQUIREMENT that parents buy health insurance on their children?

sometimes it costs less to buy an individual plan for an adult child than to add them to a parent's plan, especially if the child lives in a region not covered by the parents' doctors or provider networks.

In most cases this is true, but some college students already have a number of issues that cannot be solved in the individual health insurance market.

I have had parents contact me about coverage on their college student children only to discover the student admits to using marijuana and other illegal drugs, has a DUI, or has psychological problems such as anxiety or depression and taking expensive medication. So in some cases they cannot get insurance and in others the cost is prohibitive to cover the pre-existing conditions.

There are also parents that call looking for health insurance for their pregnant college student.

Sorry, it doesn't work that way. You buy insurance BEFORE you need it.

So what we see is few college students buying coverage on their own and the ones going on mom & dad's insurance are those that can't get private insurance in the open market.

The eHealth survey of 500 parents of full-time college students and recent grads shows just how uneasy parents are about the costs of the new provision.

43% of parents would keep their adult kids on their plan only if it was free.
38% of parents said they don't plan to keep their kids on their health insurance plan until age 26.
30% said less than one year was the fairest amount of time to provide adult kids with health insurance.
56% said they would either not provide any financial assistance at all or do so for one year or less.

Not so surprising.

Free is what many seem to expect when it comes to health insurance. Especially Obamacrap.

Poor Get Pot at a Discount

If you live in D.C. and cannot afford marijuana, taxpayers will subsidize the cost of the drug. No, I am not blowing smoke on this.

The medical marijuana law allows people to legally obtain the drug for medical reasons. But the law also includes a provision different from the 14 other states with medical marijuana laws, requiring the drug to be provided at a discount to poor residents. Who will get the reduced-price marijuana and how much it will cost, however, is still being worked out

Smoke 'em if you got 'em.

Is Medical Marijuana Covered by Obamacare?

Michael Schundler asks some good questions about the future of health insurance under Obamacare. This is just one of them.

Why do California residents have so many individuals that need marijuana for medicinal purposes? Should it be covered under their health care insurance?

Now, what was the question?

Hey man. Got any munchies?

"Alternative Medicine" Update x3

Bob alerted me to this great news:

"A Tacoma-based blood center offers donors a deal: Give a pint of blood, get a pint of beer."

Hey, if that's all it takes to motivate folks to "give a little," I'm all for it. On the other hand, I'd hate to see this taken to its (potentially) logical conclusion:

"A Seattle-based organ transplant center offers donors a deal: give a kidney, get a mocha latte."

And speaking of reality-bending medicinal applications:

"The New Jersey Legislature has approved a bill allowing chronically ill patients access to marijuana for medical reasons."

As we've noted before, these initiatives enjoy the (so far) tacit approval of the Obamastration.

One wonders when beer and pot will be approved expenses for FSA's.

Musical Marijuana

[Welcome Industry Radar readers!]

Musical legend Carlos Santana wants President Obama to legalize pot.

"Legalize marijuana and take all that money and invest it in teachers and in education. You will see a transformation in America."

Invest marijuana profits (or taxes on the sale and/or profit) to invest in education. Interesting concept. Since Congress is adding a tobacco tax to fund the SCHIP health care plan, why not legalize pot and tax it for education?

Maybe he is on to something.

"I really believe that as soon as we legalize and decriminalize marijuana we can actually afford a really good governor who won't keep taking money away from education and from teachers and send him back to Hollywood where he can do 'D' movies and we can get an 'A' governor," continued Santana, referring to former movie star and current California Gov. Arnold Schwarzenegger.

Here in Georgia we legalized gambling (state run lottery) and used that tax to fund education. Of course we are still 48th or so in the nation but imagine where we would be if not for the lottery tax on the poor?

Up In Smoke

Feeling nauseous from chemotherapy? Take a hit of weed.

Medical marijuana has been the butt of jokes for some time. The use of marijuana to offset the side effects of chemo is well known but only legal in a few jurisdictions.

But it seems the new Washington regime is sending a message there is a new sheriff in town and he is here to clean things up.

The Obama administration isn’t going to bust stores that are following state laws allowing the sale of marijuana when approved for use by a doctor. But the DOJ will go after stores being used as fronts for drug dealers, Attorney General Eric Holder said yesterday.

It’s been clear for a while that the Obama administration would depart from the Bush administration’s practices of using the DEA to bust marijuana dispensaries that officials said were following state law but violating federal law, which doesn’t recognize a medical use of marijuana.

So who has jurisdiction here? The feds and the DEA or the state of Cah-lee-for-neeah?

According to U.S. Attorney General Eric Holder . . .

The policy is to go after those people who violate both federal and state law, to the extent that people do that and try to use medical marijuana laws as a shield for activity that is not designed to comport with what the intention was of the state law. Those are the organizations, the people, that we will target. And that is consistent with what the president said during the campaign.

Sounds like "lawyer speak" to me.

High Blood Pressure? That Stinks!

[Welcome FoxNews readers!]

Sometimes, we at IB face a dilemna: as a "family-friendly" blog, where do we draw the line between licentious and useful? For example, did you know that that which makes flatulence odoriferous (and the delight of 5th grade boys the world over) also serves a more noble bodily function?

"A smelly rotten-egg gas in farts controls blood pressure in mice, a new study finds."

Sorry, but science is science.

Turns out, the gas is created by bacteria making its home in our digestive system, and that (according to new research) it helps regulate blood pressure by acting as a sort of "steam valve," much like the little gizmo on top of a pressure cooker. That gas, hydrogen sulfide, is responsible for the offending aroma.

The scary part, one supposes, comes from its potential application in medical tech. According to Dr Solomon Snyder, a neuroscientist at Johns Hopkins, "(n)ow that we know hydrogen sulfide’s role in regulating blood pressure, it may be possible to design drug therapies that enhance its formation as an alternative to the current methods of treatment for hypertension.”

Well, it was only a matter of time that we'd get from medical marijuana to medicinal methane.