Uninsured costs hurting medical marijuana patients

Milton resident Todd Boone estimates that he’s spent more than $10,000 on medical marijuana since First State Compassion Center, the state’s only dispensary, opened its doors in June of last year.

Boone said being able to purchase the medicine legally is better than not, but because the U.S. Food and Drug Administration hasn’t give the seal of approval to the plant as a medicine, his insurance doesn’t cover the costs. As a result, he said, he’s paying for everything out of pocket.

“If I wasn’t allergic to opioids, my insurance would cover those, but then I’d probably be on heroin in a year,” he said recently from his small, one-room apartment on the outskirts of Milton.

Injured badly in a motorcyle accident in 2008, Boone said marijuana has been a lifesaver. He broke his collarbone, lost a couple of toes, injured his back and neck, and still gets severe migraines.

At the time of his accident, Boone, who has filed a lawsuit against the state centered around the slow pace of implementing the state’s medical marijuana program, didn’t have insurance at the time of the accident. He said the doctors bandaged him up and then sent him home with a bunch of Percocets, an opioid pain medication.

That was when Boone found out he was allergic to the insurance-covered painkillers. Within 20 minutes of taking the first pill, Boone said, his throat began to close up and he couldn’t breathe.

The state’s Department of Insurance regulates the insurance industry and the services it provides. Franklin Pyle, Delaware Insurance Department director, said in an email that medical marijuana has not been recognized as a drug by the U.S. Food and Drug Administration.

“Due to it not being listed as a drug, even though it has been legalized in numerous states, it is considered as an over-the-counter product. Thus it is not a covered prescription and is not paid for by insurers and Medicaid alike,” said Pyle in an email.

Pyle left the door open for possible insurance coverage, adding FDA testing is still ongoing.

For the FDA, it’s about safety and effectiveness.

Michael Felberbaum, an FDA representative, said the FDA is aware marijuana or marijuana-derived products are being used for a number of medical conditions, but, he said, to date, the FDA has not approved a marketing application for a drug product containing or derived from botanical marijuana.

“This means that the FDA has not found any such product to be safe or effective for the treatment of any disease or condition,” Felberbaum wrote in an email.

Felberbaum said the FDA has approved the use in the United States of at least two synthetically produced drugs – Marinol and Cesamet – that have similar chemical makeup of the marijuana plant. Marinol is used for the treatment of anorexia associated with weight loss in AIDS patients, and includes the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC) which is considered the psychoactive component of marijuana. Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC.

Felberbaum said the FDA will continue to facilitate the work of companies interested in bringing safe and effective products to the market, but the study of marijuana in clinical-trial settings is needed to assess safety and effectiveness of marijuana for medical use.

Issues with First State Compassion Center

For Boone, it’s not just the lack of insurance coverage. He also has a problem with the prices of the medicine sold by First State Compassion Center.

“It’s cheaper for me to get the marijuana I need on the streets,” he said.

State law allows a person with a medical marijuana card to purchase up to 3 ounces of product every 14 days. Boone makes his own tinctures, an hours-long process that turns the active ingredients from the flower of the plant into liquid form. Making the tinctures also maxes out his purchasing capabilities.

Boone said sometimes First State doesn’t have ounce packages for sale, so he has to buy smaller amounts, which is more expensive.

“Those are drug-dealer tactics,” he said.

Mark Lally, First State Compassion Center president, said he’s not allowed to talk about price specifics because that would be tantamount to advertising, and by state law the company isn’t allowed to do that. He said as a not-for-profit business, First State offers the lowest prices possible, and the majority of patients buy grams and eighths of ounces. He said the margins for running the compassion center are very tight, and the goal is to supply the largest number of patients possible.

“We basically package to demand,” he said.

As far as street-dealer tactics, Lally dismisses the notion. Street dealers don’t have a knowledgeable staff and don’t test their products for safety, he said.

The state has recently accepted nearly a dozen proposals for opening dispensaries in Kent and Sussex counties. It could be months before the state selects a vendor.

Emily Knearl, spokeswoman for Delaware Department of Health and Social Services, said the committee examining the proposals is expected to meet June 21. At that time, she said, they may select one or more potential vendors for each county for contract negotiations.

In the meantime, First State is the only place where the state’s medical marijuana users may legally purchase their medicine.

Chapman Dickerson is a consultant for AQUSCAN Delaware Inc., one of the entities that submitted a proposal to open a new dispensary. He currently lives in Massachusetts, but his father is a medical marijuana patient in Delaware, and he said if AQUSCAN were selected as the winning bid, he would move here the next day.

Dickerson said he has heard from patients in Delaware that First State’s prices are high, but he said without looking at their books he couldn’t for sure say why.

One thing he knows for sure, he said, is that having a growing and cultivating operation completely indoors, as First State does, is extremely expensive and, in his opinion, an unsustainable business model. He estimated that at least one-third of First State’s overhead is in their electric bill. As part of his proposal, Dickerson submitted a plan that calls for a 10-acre greenhouse in a business park on the outskirts of Dover.

“It’s tough to argue in favor of using a warehouse,” he said. You can’t beat natural light.”

Lally said First State has also submitted a proposal to the state for the southern two counties. He responded to Dickerson’s comments by saying it was all “quite speculative.”

First State is always looking for ways to improve customer service, said Lally, and while a greenhouse operation is an attractive option, there are uncontrollable variables. He then listed off pest intrusion, the sun as an undependable light source and Delaware’s four seasons of weather.

“We won’t sacrifice the safety and affordability of our product,” said Lally.

Greenhouse or not, the patients are the ones buying the uninsured product, and Boone said something needs to change.

“This is my paycheck and 75 percent of it is going to my medicine right now,” he said.