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New Mexico Lawsuit Seeks Insurance Coverage for Medical Cannabis

Six medical cannabis patients and a New Mexico cannabis business have brought a class action lawsuit seeking insurance coverage. Legal action was filed Friday at Albuquerque’s state district court. Plaintiffs claim that medical cannabis is an acceptable behavioral health service, and therefore should be included in the insurance coverage.

Plaintiffs are New Mexico Top Organics Ultra Health, six patients who have used medical cannabis including Sen. Jacob Candelaria. The case documents show that Candelaria is a medicinal cannabis patient from 2019 when his doctor suggested that he try medical cannabis as a treatment for post-traumatic Stress Disorder. Candelaria, who is not covered by Blue Cross Blue Shield New Mexico for medical cannabis, pays $500-1000 per month.

With the legal action, the plaintiffs in the case are seeking “recovery for themselves, and for every other similarly situated behavioral or mental health patient unlawfully subjected to paying for the entire cost of medically necessary cannabis, in violation of state law.”

Blue Cross and Blue Shield of New Mexico and True Health New Mexico are named as defendants. Legislation passed in April 2021, Senate Bill 314, requires that all insurers pay 100% for the cost of behavioral healthcare services. This includes treatments for mental health conditions. This law was approved in April 2021, and became effective January 1, 2019.

“The idea of health insurance plans paying for medical cannabis may seem like an impossible dream, but all the foundational elements have already fallen into place,” Ultra Health president and CEO Duke Rodriguez said in a statement to the Albuquerque JournalMonday. “Revolutionizing behavioral health care in New Mexico will take only a few small steps, rather than a giant leap.”

February letter sought coverage for medical cannabis New Mexico

Ultra Health, in February, sent an email to the Office of the Superintendent of Insurance and insurers asking them to provide coverage for the medical marijuana recommended for treating behavioral health conditions. In the letter, Ultra Health included April data, which showed that 73,000 of the 134.307 state patients enrolled under the medical marijuana program have been diagnosed by PTSD.

“Ultra Health acknowledges that the idea of health insurers paying for medical cannabis may seem novel at first blush,” the company wrote in its letter to Presbyterian Healthcare Services. 

“However,” the letter continues, “it is actually a rational, reasonable notion when considered in light of other New Mexico law. New Mexico has already made it mandatory for workers’ compensation insurers that medical cannabis be paid for. New Mexico treats medical cannabis in the same manner as traditional prescription medicines. The fact that health insurers should—and will—pay for medical cannabis is not revolutionary at this point. It is the next logical step, and it is a small step, not a giant leap.”

According to media reports, True Health New Mexico and Blue Cross and Blue Shield of New Mexico did not comment on this case. Cigna, Western Sky Community Care, Molina Healthcare of New Mexico and Western Sky Community Care did not respond immediately to inquiries for comment. Presbyterian Health Plan and Presbyterian Insurance Co., which are overseen by the same management team, also declined to comment on the case but issued a statement on the companies’ policies.

“Presbyterian Health Plan is committed to ensuring that New Mexicans can access the behavioral health services they need,” spokeswoman Melanie Mozes said. “We have not yet been served with the lawsuit and will reserve comment for the appropriate venue.”

Rodriquez stated that Rodriquez filed the suit after state regulators and insurers did not respond to Rodriquez’s February letter. He also noted that other patients who have been impacted by the insurers’ failure to cover medical cannabis prescribed as a behavioral health treatment are welcome to join the legal action.

“There will be more patients identified who have been harmed by insurers not lawfully abiding to the statutory duty of eliminating any cost sharing related to behavioral health services,” Rodriguez said. “Insurers have not acted in good faith.”

Candelaria stated that cannabis medical marijuana has been a positive influence on his life and helped him with PTSD. He added that he joined the legal action to help all “New Mexicans who are struggling to pay for their health care.”

“Senate Bill 317 was transformational,” Candelaria said. “This suit, you know, it becomes necessary to actually make that transformation happen.”