Reimbursement Policy for Cannabis for Medical Purposes

Issuing Authority: Director General, Policy and Research
Effective Date: May 15, 2017

Purpose

  1. This policy provides direction on the reimbursement of cannabis for medical purposes.

General

  1. Access to the use of cannabis for medical purposes has been mandated by Canada’s courts. Health Canada’s Access to Cannabis for Medical Purposes Regulations specify the conditions for authorization and legal possession. Cannabis is not an approved therapeutic product in Canada.
  2. There have been limited trials which seem to support the use of cannabis in limited circumstances as an option after standard interventions are contraindicated or have been tried and have been unsuccessful and/or have yielded unacceptable adverse effects. Veterans Affairs Canada has heard from Veterans and their advocates that they believe cannabis helps them with their health problems. This information must be balanced with scientific evidence, sound clinical practice, and with the primary concern of the Department - the health and general well-being of Veterans and their families.
  3. Recognizing that the use of cannabis for medical purposes continues to be an emerging practice, Veterans Affairs Canada will continue to monitor developments in research, and medical practice and experience, and adjust the policy provisions as may be required.

Authority

  1. Subject to the provisions of this policy, reimbursement may be authorized for eligible Veterans and other qualified individuals in accordance with section 4 of the Veterans Health Care Regulations.

Eligibility

  1. Veterans entitled to a Veterans Affairs Canada Disability Pension and/or Disability Award are eligible for the cost of treatment in respect of their pensioned/awarded condition (see Treatment in Respect of a Pensioned or Awarded Condition Policy). Certain Veterans may also be eligible for the cost of treatment for non-pensioned/awarded conditions to the extent the treatment is not available from the province/territory in which they reside (see Eligibility for Health Care Programs – Eligible Client Groups).

Policy

  1. Veterans Affairs Canada may reimburse an eligible Veteran for the costs of cannabis for medical purposes, when the health care practitioner’s (defined in Health Canada’s Access to Cannabis for Medical Purposes Regulations as a medical practitioner or a nurse practitioner) authorization is in accordance with Health Canada’s Access to Cannabis for Medical Purposes Regulations. The authorization document completed by the health care practitioner indicates the amount of grams per day of dried marihuana.
  2. Veterans Affairs Canada, requires the following documents to confirm the Veteran meets the requirements of Health Canada’s Access to Cannabis for Medical Purposes Regulations for the purposes of determining entitlement for reimbursement:
    1. copy of the authorization document completed by the health care practitioner; and,
    2. copy of the completed and confirmed registration document with a licensed producer.
  3. Veterans Affairs Canada will only accept authorization from one health care practitioner at a time. More than one authorization may be considered, but the authorizations must be from the same health care practitioner.
  4. Eligible forms of cannabis include all forms that are authorized by section 3(1) of Health Canada’s Access to Cannabis for Medical Purposes Regulations for sale by licensed producers (with the exception of seeds and plants). Currently, licensed producers may produce and sell dried and fresh marihuana, and cannabis oil.
  5. The maximum daily Veterans Affairs Canada reimbursement limit is 3 grams per day of dried marihuana (or the equivalent in other eligible forms).
  6. Requests for reimbursement for more than 3 grams of dried marihuana (or the equivalent in other eligible forms), will require additional information for consideration as set out in Annex A. This applies to those being reimbursed for more than 3 grams per day on the coming into force of this policy, and all new requests. 
  7. Veterans Affairs Canada will reimburse the Veteran based on a fixed rate per gram of marihuana, when authorized in its dried or fresh form or the same fixed rate per gram equivalent in cannabis oil. In other words, Veterans Affairs Canada will reimburse the Veteran at a fixed rate per gram whether taken in fresh or dried marihuana, or the equivalent in cannabis oil. 
  8. Veterans Affairs Canada does not reimburse the cost of cannabis for medical purposes when the Veteran purchases cannabis outside Canada. The legislative regime established by Health Canada for access to cannabis for medical purposes includes regulatory requirements for the safe production and distribution of cannabis, and for legal possession. Recognizing the complexity and variety of approaches internationally, the Department is not able to adequately ensure the same level of regulatory oversight for the safe production, authorization, distribution, and legalization of cannabis for medical purposes. The health and well-being of Canada’s Veterans is paramount, and the varied approaches to cannabis for medical purposes is of concern
  9. Veterans Affairs Canada only reimburses the cost of cannabis for medical purposes when the product is purchased from a licensed producer (with the exception of seeds and plants). Canada has established a regulated system of licensed producers that ensures producers are meeting standards for quality and safety. This standardization is an essential consideration when determining whether to reimburse Veterans for cannabis for medical purposes. The health and well-being of Veterans is best ensured through accessing cannabis produced by the licensed producers authorized in accordance with Health Canada’s Access to Cannabis for Medical Purposes Regulations
  10. No fee is paid to the physician for the completion of the authorization document since VAC considers it to be covered in insured service fees. However, if the Department requires the health practitioner to complete additional documentation, an administrative fee may be paid.
  11. Veterans Affairs Canada may deny approval of reimbursement when licensed producers are determined to be operating outside of the requirements of Health Canada’s Access to Cannabis for Medical Purposes Regulations, the requirements of this policy, and/or any approved provider criteria established by the Department and agreed to by the licensed producer.
  12. Reimbursement for the cost of the purchase of a vaporizer may be authorized for eligible Veterans up to the established dollar limit. The purchase must be pre-authorized, and prescribed by a health practitioner. Veterans Affairs Canada may consider other “equipment” when the device is medically beneficial, subject to the provisions of the Medical Supplies policy.

Annex A

Exceptional Approval of More than 3 Grams

  1. Reimbursement may be authorized for more than 3 grams of dried marihuana or equivalent when confirmation is received from the treating physician that the Veteran is palliative. In end of life situations, documentation is not required from a medical specialist.
  2. Palliative care is defined in the Palliative Care policy. The policy also includes additional considerations for Veterans requiring end of life care.
  3. When authorization of cannabis for medical purposes is for Amyotrophic Lateral Sclerosis (ALS), validation of the diagnosis from the attending physician will be required.

Other Exceptional Requests

  1. In all cases, other than the circumstances as noted above, requests for reimbursement of more than 3 grams of dried marihuana or equivalent must be accompanied by additional documentation from a medical specialist. The required documentation from the medical specialist must indicate:
    1. the rationale for the use of more than 3 grams per day;
    2. there are no contraindications to the use of marihuana; and
    3. alternative treatments were found to be ineffective or contraindicated.
  2. When authorization of cannabis for medical purposes is for chronic pain, additional documentation will be required from a medical specialist in the area of the treatment of chronic pain.
  3. When authorization of cannabis for medical purposes is for a psychiatric condition(s), additional documentation will be required from a psychiatrist.
  4. When both chronic pain and a psychiatric condition are present, additional documentation will be required from either a medical specialist in the treatment of chronic pain or a psychiatrist.
  5. For any other health conditions, additional documentation will be required from a medical specialist with expertise in the diagnosed condition, including but not limited to chemotherapy-induced nausea and vomiting, wasting syndrome, or loss of appetite in AIDS and cancer patients.

Access to Cannabis for Medical Purposes Regulations

Veterans Health Care Regulations

Health Care Programs – Eligible Client Groups

Treatment in Respect of a Pensioned or Awarded Condition

Palliative Care

Medical Supplies

Cannabis for medical purposes

Consumer Information - Cannabis (Marihuana, marijuana)

Information for Health Care Professionals: Cannabis (marihuana, marijuana) 

Care has been taken to ensure these policies accurately reflect the acts and regulations. Should any inconsistencies be found, the acts and regulations will prevail.

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