BIP Winter 2025

Industry Innovation

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4. Education first • Member-friendly materials on onset, duration and side effects • Expectations on function at work and impairment rules • Manager and HR talking points to reduce stigma and confusion 5. Compliance and policy alignment • State law mapping for medical programs and employment protections • Coordination with drug-free workplace, DOT and safety policies • Privacy, data-sharing and ERISA documentation When used appropriately, cannabis can sometimes replace or reduce prescription burden, improve tolerance to necessary treatments and support adherence. — CannaCoverage ”

Guardrails brokers should insist on From an education and fiduciary perspective, the panel urged brokers to treat cannabis like any high-impact therapy class: 1. Clinical governance • Physician oversight with indication-specific protocols • Standardized intake, baseline assessments and follow-up intervals • Clear exclusions (e.g., preg nancy, certain psychiatric histories) 2. Product quality and safety • Laboratory testing, chain of custody and dose consistency • Preference for non-combusti ble routes when appropriate • Workplace safety guidance for safety-sensitive roles 3. Utilization management • Prior authorization tied to diagnosis and past therapy • Quantity limits and taper plans when goals are met • Drug-drug interaction screening

Cost and outcomes: what to watch The presenters shared experience from public sector adoption in New Jersey and pointed to analyses where medical cannabis availability coincided with Rx savings (including Medicare populations) and lower plan spend in selected cohorts. They cautioned that results depend on program design: savings are most plausible when cannabis prevents higher-risk escalation (e.g., long-term opioids), supports adherence to effective but difficult treatments or replaces specific high-cost drugs in eligible members. Measurement basics include: • Pre/post utilization of target drug classes • ER and inpatient use for pain crises or adverse events • Chemo completion rates where side-effect manage ment is the goal • PROMs (patient-reported outcomes) for pain, function and sleep but it is an increasingly evi dence-informed option in the benefits toolkit. Proper guard rails may support better symptom control, adherence and member experience while offering targeted opportu nities to moderate costs. For brokers, the work is educational and fiduciary first: translate the science, set the rules, measure the results and keep members safe. Medical cannabis is not a one-size-fits-all solution,

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14 bip magazine Winter 2025