Insurers sued over cannabis coverage

Copyright © 2022 Albuquerque Journal

New Mexico Top Organics-Ultra Health and six medical patients have filed a class-action lawsuit, arguing that insurers should shoulder the cost of medical cannabis because it is a behavioral health service.

The lawsuit was filed on Friday in state district court in Albuquerque against seven insurers in the state – Blue Cross and Blue Shield of New Mexico, True Health New Mexico, Cigna Health and Life Insurance Co., Molina Healthcare of New Mexico, Presbyterian Health Plan, Presbyterian Insurance Co. and Western Sky Community Care – for failure to cover medical cannabis costs.

Plaintiffs in the lawsuit are seeking “recovery for themselves, and for every other similarly situated behavioral or mental health patient unlawfully subjected to paying for the entire cost of medically necessary cannabis, in violation of state law.”

“The idea of health insurance plans paying for medical cannabis may seem like an impossible dream, but all the foundational elements have already fallen into place,” Ultra Health President and CEO Duke Rodriguez said in a statement on Monday. “Revolutionizing behavioral health care in New Mexico will take only a few small steps, rather than a giant leap.”

True Health New Mexico and Blue Cross and Blue Shield of New Mexico declined to comment. Molina Healthcare of New Mexico, Western Sky Community Care and Cigna didn’t immediately respond to requests for comment.

Presbyterian Health Plan and Presbyterian Insurance Co. – which fall under the same leadership structure – also declined to comment.

“Presbyterian Health Plan is committed to ensuring that New Mexicans can access the behavioral health services they need,” spokeswoman Melanie Mozes said. “We have not yet been served with the lawsuit and will reserve comment for the appropriate venue.”

The heart of the lawsuit, according to Rodriguez, stems from legislation that passed in 2021. Senate Bill 317, signed by Gov. Michelle Lujan Grisham in April 2021, focuses on behavioral health cost sharing. The law – which went into effect on Jan. 1 – states that insurers should cover 100% of behavioral health services, including the prescribed treatment of a behavioral health condition.

More than 73,000 medical patients of the 134,307 patients enrolled in the medical cannabis program in the state suffer from PTSD, according to April data from the New Mexico Department of Health.

In February, Ultra Health sent a letter to New Mexico health insurers and the Office of the Superintendent of Insurance seeking assurance that cannabis coverage is a behavioral health service under the law. But Ultra Health said the state and insurers have yet to respond to that letter.

Rodriguez said the lawsuit opens the doors for more medical patients to join in.

“There will be more patients identified who have been harmed by insurers not lawfully abiding to the statutory duty of eliminating any cost sharing related to behavioral health services,” Rodriguez said. “Insurers have not acted in good faith.”

The six medical patients listed as plaintiffs, most notably, includes state Sen. Jacob Candelaria.

Candelaria, according to the lawsuit, has been a medical patient since 2019 at the behest of his physician who recommended he use cannabis to help treat his post-traumatic stress disorder after having little success using antidepressants.

According to the lawsuit, he spends between $500 and $1,000 a month on medical cannabis and has paid entirely out of pocket since becoming a medical patient. He is insured with Blue Cross and Blue Shield of New Mexico, according to the lawsuit.

In an interview with the Journal on Monday, Candelaria described his experience with medical cannabis in treating his PTSD, saying it has had a positive effect on his life. He said he signed onto the lawsuit not for his own benefit, but for the many “New Mexicans who are struggling to pay for their health care.”

“Senate Bill 317 was transformational,” Candelaria said. “This suit, you know, it becomes necessary to actually make that transformation happen.”

Other plaintiffs are Tomas Lorenzo Valencia, Bryce Bryant-Flynn, Matias Trujillo, Erica Rowland and Ariel McDougal – all of whom are medical patients.

Medical cannabis became legal in New Mexico under then-Gov. Bill Richardson, who signed off on the legislation known as the Lynn and Erin Compassionate Use Act, in 2007.