BIP Winter 2025

GETTING STARTED: a broker’s checklist ✔ Map state laws and employment policies; brief HR and legal. ✔ Identify priority use cases aligned to population needs. ✔ Select a vetted clinical partner with protocols and reporting. ✔ Define coverage criteria, safety rules and UM. ✔ Build member education that sets expectations and reduces risk. ✔ Establish metrics, baselines and a 6–12 month evaluation plan.

higher-cost agents, with close clinical supervision. When used appropriately, cannabis can sometimes replace or reduce prescription burden, improve tolerance to necessary treatments and support adherence. These effects can flow through to medical and Rx trend, disability and productivity. What the science (and history) suggest The panel traced the clinical context from cannabis’ pre-prohibition use in the

They stressed that evidence quality varies by indication and product, and that dose, route

and formulation matter. Where it can fit in employee benefits Because legality, product

standards and reimbursement differ by state, there is no single blueprint. The speakers outlined models they’ve seen employers consider — especially in self funded plans: • Structured medical benefit for qualifying indications with physician certification, defined dose forms and utilization controls (e.g., prior authori zation, quantity limits, step therapy with documented intolerance or failure of con ventional options). • Supplemental carve-out administered by a specialized vendor with clinical triage, education and safety checks, reported back to the plan alongside PHI safeguards. • Stipend or reimbursement approach with medical-neces sity criteria, recognizing tax implications and the need for documentation. • Care navigation + educa tion even without coverage, to steer members toward evidence-based indications, avoid unsafe products and reduce trial-and-error. For fully insured groups, coverage is typically constrained by carrier policy; brokers can still bring vendor education, navigation and harm-reduction resources.

As state policies evolve, brokers have a real opportunity to lead by asking employers the right questions, finding credible partners and helping clients

U.S. pharmacopeia to today’s research on the

navigate the compliance and care

considerations around medical cannabis.

PetroliniVideo / iStock

endocannabinoid system, our body’s receptors that interact with cannabinoids. That biology underpins why cannabis appears to exert effects across pain, sleep, nausea, appetite and mood.

Winter 2025 bip magazine 13