The Pharmacist’s Role in Third-Party Reimbursement of Medical Cannabis

Bill A5760, sponsored by NJ Assemblyman Herb Conaway (D-Burlington) and Ralph Caputo (D-Essex), seeks to have medical cannabis subsidized by multiple 3rd-party payors: Catastrophic Illness in Children Relief Fund, Pharmaceutical Assistance to the Aged and Disabled (PAAD), Senior Gold Prescription Discount Program, and the Victims of Crime Compensation Office (VCCO).

With the hopeful passage of this bill, I estimate only a small portion of registered patients in the New Jersey Medical Marijuana Program would be eligible for coverage, but it’d be a welcomed start! With medical cannabis products costing patients approximately $500/oz in NJ, any extra opportunity for monetary relief including workman’s compensation should be examined closely. Pharmacists have an opportunity to exercise valuable harm-reduction measures as well as cost-reduction interventions due to language woven into the fine print of this bill about patient purchasing limits.

Pharmacists working in traditional retail settings are expected to proficiently master third-party billing systems. Their daily routine includes calculating precise day supplies and ensuring prescription medications are dispensed in the intended quantities and package size intervals to submit for reimbursement from pharmacy benefit managers. A pharmacists’ familiarity with organization and electronic record-keeping is a byproduct of an industry that’s consistently improving technological efficiencies. My personal experience coming from the above-mentioned environment allowed me to instantly decipher and navigate our cannabis POS system to replicate a similar working logic. What other pharmacist skills can positively translate into this conversation?

It starts with the ability to conduct an advanced patient counseling session. Simply identifying a patient’s qualifying condition is easy, but medical dispensaries without a pharmacist may not be equipped to handle the more complex task of discerning specific disease presentations and a patient’s full medication profile. Our educational background consists of understanding disease etiologies and pairing them with practical clinical intervention techniques. Pharmacists qualified to conduct medication therapy management (MTM) services will be able to easily translate those skills to assess and recommend specific dosage forms, dosing regimens, and quantities of medical cannabis a patient requires. From a harm-reduction standpoint, pharmacists focus on proactively identifying drug-drug interactions, monitoring for duplicate therapies, and mitigating adverse effects improving clinical outcomes. States like New York and Pennsylvania that require a pharmacist to be on-site at a medical cannabis dispensary during operational hours allow patients to reduce their trial-and-error costs due to structured educational counseling sessions and more focused guidance in selecting products based on individual medical needs. These cost-saving measures will be passed on to the 3rd-party payors and ties directly into the last point.

Cost reduction/minimization is imperative from the lens of any 3rd-party payor. The ramifications of people taking advantage of billable medical services continue to plague healthcare systems even with recent COVID-19 diagnostic testing for patients. Pharmacists are required to undergo continuous Fraud, Waste, and Abuse (FWA) training from the U.S. Centers for Medicare and Medicaid Services (CMS). These required training programs help establish fundamental expectations for compliance, disclosure, transparency, and quality of care. Pharmacists are also already accustomed to upholding rigorous regulations set forth by the Board of Pharmacy in their respective states.

All in all, the conversation of third-party coverage must continue regardless. Pharmacists are uniquely positioned to be both providers of exceptional medical care and agents to strengthen professional accountability. Meaningful progress continues one voice at a time and change happens when those voices are loud, clear, and in the same direction.

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