Prescription cannabinoids showed effectiveness for MS spasticity and pain, but herbal marijuana coverage remains unlikely | Research

The takeaway

The AAN review justified insurance coverage for dronabinol and nabilone for MS spasticity and pain, but herbal marijuana remains federally illegal and uncovered by payers.

Read this if you have a neurological condition and are navigating cannabis treatment options and insurance coverage.

Dronabinol and nabilone: insurance coverage justified for MS indications

What the researchers found

This commentary examined the clinical implications of the American Academy of Neurology's systematic review of cannabinoids for neurological disorders. Several cannabinoid preparations showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis.

The authors noted that the review supports insurance coverage for prescription cannabinoids dronabinol and nabilone for MS indications, and many insurers already covered these medications for other approved uses. However, the review was unlikely to change coverage for herbal marijuana because it remains illegal under federal law.

For other neurological conditions, the available evidence was insufficient to support clinical recommendations. The commentary highlighted the gap between the scientific evidence for pharmaceutical cannabinoids and the accessibility issues created by marijuana's federal scheduling.

Why it matters

The disconnect between available pharmaceutical cannabinoids (covered by insurance) and herbal cannabis (not covered, federally illegal) creates inequity in patient access. This commentary helps clinicians understand what they can practically prescribe and what insurance will cover.

The numbers in context

Cannabinoids showed effectiveness or probable effectiveness for 3 MS indications: spasticity, central pain, painful spasms. Insurance coverage supported for dronabinol and nabilone. Quality evidence lacking for other neurological conditions.

How the study worked

Clinical perspectives commentary on the AAN evidence-based systematic review of randomized controlled trials of cannabis and cannabinoids in neurological disorders, with analysis of insurance and coverage implications.

What this study cannot tell us

Commentary based on a single systematic review. Coverage policies vary by insurer and jurisdiction. The distinction between pharmaceutical and herbal cannabis may oversimplify the therapeutic landscape. Published before many states expanded medical programs.

How to read the evidence

Clinical commentary based on the AAN systematic review of randomized controlled trials.

When this study was published

Published in 2015. Cannabis scheduling and insurance policies have evolved since.

The bigger picture

The medical cannabis landscape involves a tension between pharmaceutical cannabinoids (regulated, studied, insurable) and herbal marijuana (unregulated, variably studied, uninsurable). This commentary makes the practical implications clear for both clinicians and patients.

Questions still open

Has federal rescheduling affected coverage since 2015? Do patients respond differently to pharmaceutical vs. herbal cannabinoids for MS? Would standardized herbal cannabis preparations become insurable?

Common questions

Will insurance cover cannabis for neurological conditions?

As of this 2015 commentary, prescription cannabinoids (dronabinol, nabilone) could be covered for MS spasticity and pain. Herbal marijuana was not covered due to federal illegality. Current coverage may differ.

Which neurological conditions have evidence for cannabis?

The strongest evidence was for MS spasticity, central pain, and painful spasms. For other neurological conditions, the AAN found quality scientific evidence lacking at the time.

Read the original research

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.

Neurology. Clinical practice, 5(4), 344-351

View on PubMed ↗

Citation

Fife, Terry D; Moawad, Heidi; Moschonas, Constantine; Shepard, Katie; Hammond, Nancy. (2015). Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.. Neurology. Clinical practice, 5(4), 344-351.