Barring U.S. Food and Drug Administration approval for marijuana treatments between now and next summer, Minnesota medical cannabis patients will have to pay entirely out of pocket for their medicine, Manny Munson-Regala, the state employee tasked with overseeing the rollout of the program, tells us.
"Until it's FDA approved [insurance companies] aren't going to pay for anything," Munson-Regala says. "All of these patients are paying out of pocket, and that's a big reason why we want to be sure they get good information about what works and what doesn't, and we have good standards around the composition of the cannabis we're getting."
Asked how much the out-of-pocket costs might be, Munson-Regala says, "It tends to be related to the effectiveness per dose, and it depends on your condition and what composition you're purchasing. But from what I understand, [in other states] the average monthly expense for a patient is a couple hundred bucks up to $1,000."
The FDA has approved medical marijuana trials for conditions including epilepsy, PTSD, multiple sclerosis, intractable pain, and Crohn's disease, among others, but it's doubtful any of the trials will be completed by July 2015, when Minnesota's medical marijuana system will be introduced.
"With states that are going toward full medical cannabis, we're saying we can't wait that long, we need to provide folks with relief today," Munson-Regala says. "And that's where it gets kinda tricky, and that's why you're getting a lot of noise from health care providers about why they're hesitant to take part in the program -- they don't have the standards they normally rely on, so if you want to think about what Minnesota is doing, we're trying to bridge the gap between the full FDA system and somewhere where patients are on their own."
In part, that means making sure patients are provided with the most thorough information possible about the cannabis extracts they'll likely pay out of pocket to purchase.
"If you're gonna be spending a couple hundred dollars to $1,000 you want to know what you're buying is good for your specific condition," Munson-Regala says. "I think we're going to learn a ton over the next couple years about what works, what doesn't, and it might get to a point of really saying, for this condition you need this specific version of cannabis in this form. Then some of that is going to be patient preference -- some prefer edibles, some vaporizers, heck, there might be patches some day."
In terms of how the state will procure cannabis, Munson-Regala says the state has "a requirement under the law to see if there's any federally available source."
"The way the bill is structured, we go to the feds first, and if they're unable to be an adequate source of medical cannabis, then we have until December of this year to register a manufacturer," he continues. The manufacturer "would be private, they could be entirely for-profit, they could be a nonprofit -- it's another process that's being fleshed out right now."
If the feds can't come through with sufficient medical cannabis -- currently, the Ole Miss campus is home to the country's only federally run medical marijuana grow-op -- then "we'll have to tell interested parties sometime by late summer, 'Here's what we're looking for in terms of an application, and here's what we're looking for in terms of the potential rules of the roads,'" Munson-Regala says.
"We'll probably have an 'interested parties conference' where you might hear folks say, 'I want to grow,' others want to do distillation, others distribute," he continues. "One of the benefits of having a conference and meeting in one place is you can imagine, given the way we've set this up, coalitions or consortiums or partnerships will develop."
From there, the state will have to figure out some sort of dispensary system.
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"It could be a sort of roving dispensary, like, 'There's a dispensary driving through Alexandria today,'" Munson-Regala says. "There has to be some process associated with distributing the medicine from the two manufacturers to the eight [dispensary] locations throughout the state. We're still chewing over how to do it."
Though the state of Minnesota can't be involved in the growing, distilling, or distribution of marijuana, Munson-Regala says the state plans to hire about 10 people, including the director of Medical Cannabis, to oversee the program.
"Given the unique status of cannabis in our country, no state can actually be in the manufacturing business themselves," Munson-Regala says. "Which is why all the growers have to be some kind of private entity."
And as part of their proposals to the state, prospective growers and distributors will have to outline how their product will be priced. Patient fees are projected to cover the public cost of administering the program.