HCi Factsheet
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Medicinal cannabis and health cover
June 2022
Cannabis can be used in Australia for Medicinal purposes under very strict regulations which vary state to state. Medicinal cannabis is now legal in Australia under tight restrictions, but is it covered by Medicare and private health cover?
What is medicinal cannabis?
Medicinal cannabis is made from the Cannabis sativa plant- also known as marijuana. Recreational marijuana comes from the same plant but has impurities and unknown quantities of active ingredients – they are not interchangeable!
Cannabis has some therapeutic value for pain relief, stopping vomiting and anti-inflammatory action. Cannabis contains 80-100 cannabinoids which act on the brain and affect mood, memory, appetite and sleep. Different cannabinoids have different impacts on the body, and this is still being researched around the world.
Growing, importing, possessing and using cannabis outside of the approved prescribed medicinal cannabis is illegal in most states of Australia.
What is medicinal cannabis used for?
The benefits of medicinal cannabis have not yet been proven as there have actually been few well designed clinical trials. There are certainly some people with terminal or chronic illnesses who get relief from taking it, but further research is required.
It is being researched for treating conditions such as epilepsy, chronic pain (non cancer), multiple sclerosis, and chemotherapy side effects. However, it’s main uses in Australia are chronic pain, anxiety and depression, sleeping disorders and inflammatory disorders.
Medicinal cannabis can cause side effects such as:
- Dizziness or vertigo
- Nausea and vomiting
- Lack of concentration
- Balance issues
- Thinking and memory problems
- Drowsiness
- Changes in appetite
- Confusion
- Hallucinations, delusions, depression, euphoria or cognitive distortion
Who can use medicinal cannabis?
In Australia, you can only access specific medicinal cannabis products through a qualified medical practitioner. These products are formulated for the greatest benefit with minimised side effects. They have been approved for some people through the Special Access Scheme by the Therapeutic Goods Administration (TGA) for restricted use. They are not registered medicines on the Australian Register of Therapeutic Goods (ARTG).
Rather than having a specific condition where medicinal cannabis can be used, eligibility revolves around trying multiple conventional treatments for your chronic condition which have not worked or have caused intolerable side effects. It can’t be a first line treatment, but it is not always a last resort. Currently, the TGA has approved medicinal cannabis for over 130 conditions!
When required, a doctor or specialist can apply to the TGA for a specific patient to receive a supply of medicinal cannabis. The doctor must meet certain laws and permit rules, which vary between states, and patients cannot apply to the TGA themselves.
Some other cannabis derived products can be prescribed by a doctor but are not approved by the TGA. In other words, they have not gone through the entire regulatory process and are not listed on the pharmacy scheme.
Can I claim medicinal cannabis under Medicare or health insurance?
Products not on the Australian Register of Therapeutic Goods (ARTG) are not listed in the Pharmaceutical Benefits Scheme (PBS). This can make medicinal cannabis an expensive option as most are not listed in the ARTG.
Medicare covers your GP appointments (regardless of what the doctor is prescribing!) and generally covers in-person cannabis clinic consultations. Medicare doesn’t cover the cost of the medication itself.
Requirements for paying a pharmacy claim
For HCi to be able to pay a pharmacy benefit, the medication must meet all the following pharmacy benefit requirements:
- must be S4 or S8 class medication (not available over the counter)
- must cost more than the PBS co-payment (currently $42.50)
- cannot be listed on the PBS
- must be listed as approved on the ARTG for use within Australia
- an official pharmacy receipt must be supplied.
As medicinal cannabis is not currently listed as approved for use within Australia on the ARTG, we do not currently have a benefit. Staff are keeping up to date with developing information and once the medication is listed on the ARTG, eligible members will be able to claim using their pharmacy benefits.
HCi used its best endeavours to ensure this information was accurate at the time of publication. From time to time, circumstances relating to the subject matter may change which may impact the accuracy of the information. This information is also general in nature and does not take into account any specific health or financial situation. Before making any decisions in relation to this information, you should consider your own financial and health situation and seek professional advice. Health Care Insurance Ltd ABN 43 009 579 088. A Registered Private Health Insurer.
