Government funding for medical cannabis

Legal medical cannabis comes in many forms and delivery methods and prices vary greatly. The cost of cannabis for a patient will vary based on a number of factors. And, while the price of medical cannabis products has come down over the past few years, many patients still report that the ongoing cost of being a patient makes legal cannabis a short term solution.

One of the reasons that medical cannabis still costs so much for patients is because there is limited financial assistance from the government. Some of the most frequently asked questions are, “Does the PBS cover medical cannabis or CBD oil?,” and, “Does private health insurance pay for medical marijuana or cbd oil?” 

If you’re a veteran, you may want to look into the benefits from Defence Health Limited Insurers (below) and then check out our DVA funding article.

Patients often call their insurers and are immediately told that their insurance company doesn’t cover medical cannabis. Unfortunately, like many other aspects of cannabis, the customer service teams at many Australian health funds lack an understanding of the space.

In this article, we’ll answer all of the questions you have about medical cannabis coverage related to Medicare, the PBS and Private Health Insurance. We spoke with at least one customer service representative from each of the private health insurers in Australia to get you a definitive answer as to whether your insurer covers medical cannabis. Here’s what we’ll cover in this article:

Does Medicare cover my cannabis doctors appointments?

There is no simple yes or no answer to this question. When accessing medical cannabis you have multiple options. People tend to either see a GP or go to a medical cannabis clinic. As you might already know, medicare often provides a rebate to help to cover GP visits.

So, if your GP is your medical cannabis prescriber, and your GP only charges you for your appointments then the answer is likely going to be; Yes, medicare will cover your medical cannabis doctor appointments.

If you go to a cannabis clinic, you’ll have to do your research. Most clinics offer Telehealth, while very few clinics offer in-person appointments. If you visit a clinic local to you and see your doctor in person, there is a chance that Medicare will also cover a portion of your appointments. It’s important that you ask the clinic, prior to your appointment if Medicare will cover any portion of costs. You can learn which clinics do and don’t offer in-person appointments in our cannabis clinics article.

Once you know if your appointment cost will be covered, then you may want to know if your medication will be covered by the PBS.

Does the PBS cover my medical cannabis or CBD oil?

Unfortunately, the answer is no. Medical cannabis is an unapproved medication in Australia. This means that it is not listed on the Australian Register of Therapeutic Goods (ARTG) because it lacks enough clinical research to meet the eligibility requirements for listing.

While the PBS only covers ARTG listed medications, the PBS does not cover the two medical cannabis products (Sativex and Epidiolex) currently listed on the ARTG.

Does private insurance pay for medical cannabis or cbd oil?

Most likely, yes. We spoke with all of the private health insurers in Australia and 72% of Australia health funds cover medical cannabis in some form.

A few of the funds only cover ARTG listed medical cannabis products (Sativex and Epidiolex) and most of them will cover any medical cannabis product as long as you are able to provide a few pieces of evidence. In order to be covered you may have to provide

  • Proof of your TGA approval
  • A letter from your doctor (usually a template can be provided by the insurer)
  • A pharmacy receipt that proves the PBS didn’t cover your medication (request this from your pharmacy as it’s a specific receipt separate from a tax invoice)

What’s important to note is that most insurers said that the product had to be prescribed via the SAS or AP pathways, which means that patients prescribed compounded products would not get reimbursement for their medications.

private health cover medical cannabis patients info
A list of insurers and status are below.

How it works

When you have an Extras plan that covers medical cannabis, you’ll usually pay part of the script fee and the insurer will cover some or all of the balance. All of the insurers that do cover cannabis said that you have to pay the PBS co-payment which in 2020 is $41 and then the insurer will begin to cover your medication. 

After the co-payment, insurers will either cover part or all of the balance of the script fee. Most will only cover a specific percentage or dollar amount per script.

Before providing a list of Australian health insurance providers covering medical cannabis, we’ll explain how to talk to your insurer about your cannabinoid medication.

How to talk with your insurer about medical cannabis

The reason we’re giving you this advice is that it’s always best to get something in writing directly from your insurer / a new insurer so that you know exactly what you’re getting with your coverage. While we did speak with representatives from all of the insurance companies, it was very difficult to get straight answers. In some cases, we spoke with a handful of people before getting a yes or no, so it’s important you re-confirm this information with your provider.

If you call your provider and they tell you that they don’t cover medical cannabis, don’t worry. Many of the customer service reps are uneducated about legal medical cannabis. When we called up the insurers there were numerous instances where the immediate answer was no. A couple of minutes later we were being thanked by the customer service rep because we had taught them something.

Here’s what you need to know about talking to your provider:

  1. Medical cannabis is covered under most private health funds’ non-PBS pharmacy, pharmacy, or non-PBS pharmaceuticals category.
  2. Even though medical cannabis isn’t on the ARTG, in order for you to get a script, the TGA gives you an approval either via the SAS program or the AP program. If you are getting a compounded product, you do not have TGA approval.
  3. If you’re having trouble with the initial customer service rep, you can tell them to ask their claims team if they cover S4 or S8 medical cannabis products that are approved by the TGA. Many reps will ask you for your product name – unfortunately giving them the name most times won’t progress the conversation. You need to talk to a manager or ask them to confirm with their claims department to get the answer.
  4. If you’re getting conflicting information from our article and your fund, it’s best to ask them who you can email to get a definitive answer and follow up that way.

Again, it’s best to make sure you have all the details of your insurance policy with relation to medical cannabis in writing before upgrading or changing policies. 

A list of private health insurers that cover legal medical cannabis

Each health fund in Australia has a range of plans. Medical cannabis is usually covered under non-PBS pharmacy, pharmacy, or non-PBS pharmaceuticals category. Because each provider has so many options, in the table below we give you a very high-level overview of each fund and their plans that cover legal medical cannabis. 

We’ve listed the names of the lowest-cost plan that covers cannabis and the annual limit for each of those plans. You’ll also see the maximum payout per script if the company was willing to provide it. 

Again, you’ll most likely need to provide the following information to your insurer:

  • Proof of your TGA approval
  • A letter from your doctor (usually a template can be provided by the insurer)
  • A pharmacy receipt that proves the PBS didn’t cover your medication (request this from your pharmacy as it’s a specific receipt separate from a tax invoice)

Three final reminders as you read this chart:

  1. Non-PBS pharmacy annual limits may be shared with other extras benefits in your policy.
  2. The plans listed are the lowest cost plans and therefore the lowest benefits.
  3. The extras and benefits listed are per-person, not a family rate.

Here’s the list

Insurer NameCovers
Legal MC
Lowest Rate ExtrasAnnual LimitMax Cover
Per Script
Plan Type**
ACA Health Benefits FundYAncillary Lite$250$50E
AHM health insuranceYLifestyles Extras$350$50E
AIA Health InsuranceYEnhanced ExtrasTBDTBDH + E
Australian UnityYBasic Extras$100100%E
BupaNNANANANA
CBHS Health FundYEssential Extras$200$50E
CDH Benefits FundNNANANANA
CUA HealthYEssential Extras$100$25H + E
Defence HealthYValue Extras$900$100E
Doctors' Health FundARTG OnlyOnly have one planNANANA
GMHBAYBasic Extras$150$21E
GU HealthYBudget 50 benefits$200100%H + E
HBF InsuranceNNANANANA
HCFNNANANANA
Health Care InsuranceNNANANANA
Health Insurance Fund of AustraliaYSaver Options$350$80E
Health PartnersYSA: Basic Extras
All other: Freedom Extras
$100
$200
$20
$40
E
health.com.auYExtras 50$350$50E
Latrobe Health ServicesYBasic Extras$250$22E
MedibankYHealthy Start Extras$500$21E
Mildura Health FundYFive Star Extras$300$35E
OnemedifundYComprehensive Extras$500$65H + E
Navy HealthYBudget Extras$200$50E
NIB Health InsuranceARTG OnlyYoung At Heart Extras$40060%E
Nurses & Midwives HealthNNANANANA
Peoplecare Health InsuranceYSimple Extras$200$50E
Phoenix Health FundYKick Start Extras 5020050%
Police HealthYOnly one Extras plan$600100%E
Queensland Country Health FundYYoung Extras$150$45E
*Railway & Transport Health FundYValue Extras*$300$35E
Reserve Bank Health SocietyYOnly one Extras plan$1,000$100E
St.Lukes HealthYSuper Extras$600$70E
Teachers HealthNNANANANA
* Transport HealthYHealthy Choices Extras$400$50E
TUH Health FundYBasic Extras$250$50
WestfundNNANANANA
*Medical cannabis scripts covered at the health fund's discretion.
** E = extras only plans available | H + E = can only get extras with hospital plan

For those of you prescribed Little Green Pharma (LGP) medicine, it’s may be worth looking into HIF. HIF and LGP worked out a deal whereby patients taking LGP medication get an increased rebate on each claim (normally $80 per script, now $105 per script until June 2022). You can learn more about this offer on the <a rel=”nofollow” href=”https://www.hif.com.au/help/claiming-information/medicinal-cannabis-and-treatment-access”>HIF</a> site.