Medical cannabis in Australia is a prescription medicine. So one of the most common questions we hear patients ask is, “Does my health insurance cover medical cannabis?” It’s an important question. While medical cannabis is becoming more affordable every year, it can add up if you use it daily.
The landscape of medical cannabis is changing quickly, and that includes health insurance coverage. Often, the answer to this seemingly simple question requires some digging. This quick guide should get you started — but be sure to confirm with your specific health insurer before making a claim.
Do Australian Health Insurers Cover Medical Cannabis?
Medical cannabis isn’t an “approved product” under the Australian Register of Therapeutic Goods (ARTG). Instead, your doctor must apply to prescribe medical cannabis under the Special Access Scheme or Authorised Prescriber programs. This affects insurance coverage for medical cannabis.
Public Health Insurance - Medicare and PBS
Let’s start with Medicare and PBS. At the time of writing, medical cannabis is not covered by Medicare or the Pharmaceutical Benefits Scheme. That’s because only some ARTG-approved products are covered on the PBS, which doesn’t include medical cannabis.
Medicare is also unlikely to cover the cost of medical cannabis consultations. Why? Because most telehealth cannabis services do not bulk bill.
Private Health Insurance
The good news is that most private health insurers cover some or all of the costs of medical cannabis prescriptions. Most insurance providers will have coverage under their General Treatment or Extras plan for non-PBS pharmaceuticals, including medical cannabis.
This is an area that is changing very quickly in Australia. We strongly encourage you to check your policy details or speak with your insurance provider to confirm your coverage.
What Does Health Insurance Cover?
Private health insurance covers prescriptions for medical cannabis from an Authorised Prescriber (aka the medical marijuana doctor) through the Special Access Scheme. These prescriptions are for branded cannabis products, which could include oils, flower, capsules, sprays, or other products.
Through a consultation, your health provider will help determine the right product, cannabinoid profile, and dose for your needs. The cost of medical cannabis will vary depending on your individual treatment plan which outlines dose and product type.. This could affect how much your health insurance will cover.
Every private health insurance policy offers slightly different coverage for medical cannabis. Typically, a provider will cover up to a predetermined maximum cost each year. They will normally also have a limit on the cost per script. You will still be responsible for paying the maximum PBS amount, which in 2022 is $42.50.
What Companies Subsidise Medical Cannabis in Australia?
As of today, the majority of health insurance companies in Australia provide some coverage for medical cannabis. The exact coverage will depend on your specific plan. Let’s compare some of Australia’s largest insurers and the best options for securing medical cannabis coverage.
Medibank offers coverage for medical cannabis under their range of Extras plans. The most affordable of these plans (Healthy Start Extras) covers up to $500, but that’s a combined limit with other Extras services like physiotherapy and mental health support.
If you opt for a more comprehensive plan, you could claim up to $600 per year for non-PBS pharmaceuticals (including medical cannabis).
Health Insurance Fund of Australia (HIF)
The Health Insurance Fund of Australia (HIF) was the first insurance company to offer coverage for medical cannabis back in 2020. All of their Extras plans (except Basic) cover the cost of non-PBS pharmaceuticals.
HIF will pay up to $80 per script for medical cannabis. On the Value Plan, you can claim up to $350 per year across a range of Extras services. The Essential Extras Plan covers up to $200 just for non-PBS pharmaceuticals.
Medical cannabis is also covered generously by Onemedifund. They’ll cover up to $65 per script (after the maximum PBS amount has been deducted). Their Comprehensive Extras Plan covers up to $500 per year for non-PBS pharmaceuticals (or $1000 per family).
nib Health Insurance and HBF
nib Health Insurance and HBF technically offer coverage for medical cannabis under non-PBS pharmaceuticals. However, at this time, only medical cannabis products listed on the ARTG are covered.
This means that the majority of medical cannabis users won’t get coverage. The only currently approved products are Epidyolex (for epilepsy) and Sativex (for multiple sclerosis).
Sector-Specific Health Care Plans
If you work in specific sectors, your health coverage will likely include medical cannabis. For example, the Defence Fund will cover up to $900 annually. Navy Health, Police Health, and Transport Health also provide coverage. Teachers’ Health, on the other hand, only covers ARTG-listed pharmaceuticals.
Bupa and HCF
Despite being two of the largest health insurers in Australia, unfortunately neither Bupa nor HCF offer coverage for medical cannabis.
This isn’t an exhaustive list — many other health insurers also include medical cannabis in their coverage. Ask your provider whether you’re covered, or look around for plans that will cover you.
What Do I Need to Know When Talking to my Health Insurer?
Making a claim in Australia for medical cannabis is usually reasonably straightforward (given they provide coverage).
Typically, the process for making a claim is:
Pay for your medication upfront
Ask for a receipt that includes the medication details, cost details, and prescriber information
Submit your claim through your insurer’s app, website, or email
Some providers will also want evidence of your TGA approval, which your prescriber can provide. Occasionally, providers will ask you or your doctor to complete additional forms before purchasing the medication. And we have seen some insurers ask for a dispensing history from your pharmacy, but that is rare.
Mostly, it’s vital that you know what your insurer needs before you purchase your medication, so you don’t get any nasty surprises. So review your policy, and when in doubt, ask.
Medical Cannabis and Health Insurance: Stay Informed
The world of medical cannabis in Australia is fast moving, so it’s worth staying informed about what your insurer covers. While cover for medical cannabis isn’t universal, it’s come a long way since 2020.
The majority of private health insurers in Australia now cover medical cannabis, including some of the largest. So do your research, keep hold of your receipts, and you should be able to reduce the cost of your medical cannabis prescription thanks to your health insurance.