Medical Marijuana Laws May Reduce Medicare Prescription Use, Spending

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In states where marijuana is legalized for medicinal purposes, Medicare's prescription drug benefit program has lowered its spending due to reduced prescription drug use.
In states where marijuana is legalized for medicinal purposes, Medicare's prescription drug benefit program has lowered its spending due to reduced prescription drug use.

Researchers from the University of Georgia have found that in states where marijuana is legalized for medicinal purposes, Medicare's prescription drug benefit program has lowered its spending due to reduced prescription drug use.

“Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly once a medical marijuana law was implemented,” wrote Ashley C. Bradford, lead study author and a master of public administration student in the Department of Public Administration and Policy at the University of Georgia. “The results suggest people are really using marijuana as medicine and not just using it for recreational purposes,” she said in a statement.

Because medical marijuana is such a political and controversial issue, these findings can give policymakers and others an additional tool for evaluating the pros and cons of legalizing medical marijuana. “We realized this question was an important one that nobody had yet attacked,” said study co-author W. David Bradford, the Busbee Chair in Public Policy in the UGA School of Public and International Affairs.

The savings from reduced prescription drug use were estimated to be $165.2 million in 2013, a year when 17 states and the District of Columbia had implemented medical marijuana laws. These findings suggest that if all of the states had allowed medical marijuana, the savings to Medicare would have been about $468 million, or 0.5% of total Part D spending for 2013; an amount that the researchers noted is “not trivial.”

The researchers analyzed data on prescriptions filled by Medicare Part D enrollees from 2010 to 2013, a total of over 87 million physician-drug-year observations, and limited the results to include only conditions for which marijuana might serve as an alternative treatment. These 9 categories, in which the Food and Drug Administration had already approved at least one medication, were anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and spasticity.

The researchers chose glaucoma in particular to compare it to the other disorders, because while marijuana does reduce eye pressure from this condition by about 25%, it only does so for about an hour. Because taking marijuana every hour is unrealistic, the researchers expected that glaucoma would not show a decrease in the number of prescription medications prescribed.

This hypothesis was correct; while fewer prescriptions were written for the other conditions — (daily doses for pain dropped to 1826, and daily doses for depression dropped to 265, for example) — the number of daily doses for glaucoma increased by 35.

“Generally, we found that when a medical marijuana law went into effect, prescribing for FDA-approved prescription drugs under Medicare Part D fell substantially. The only exceptions were for spasticity- and glaucoma-related drugs,” the authors wrote.

Policies for the appropriate use of medical marijuana are under ongoing debate, and each of the 25 states and the District of Columbia with medical marijuana laws have different guidelines for its use and possession limits. Physicians in these states may also only recommend its use, not prescribe it as a medication. Patients may purchase marijuana from dispensaries –not pharmacies; they may also grow it themselves(the legality of possessing marijuana plants varies by state). The lack of oversight by trained healthcare professionals worries David Bradford.

“Doctors can recommend marijuana and in some states can sign a form to help you get a card, but at that point you go out of the medical system and into the dispensaries,” he said in a statement. “What does this mean? Do you then go less frequently to the doctor and maybe your non-symptomatic hypertension, elevated blood sugar, and elevated cholesterol go unmanaged? If that's the case,  that could be a negative consequence to this.”

The researchers will explore these consequences further in their next study, which will examine medical marijuana's effects on Medicaid.

“Lowering the costs of Medicare and other programs is not a sufficient justification for approving marijuana for medical use, a decision that is complex and multidimensional. Nonetheless, these savings should be considered when changes in marijuana policy are discussed,” the authors concluded.

Reference

Bradford AC, Bradford WD. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part  DHealth Affairs. 2016;35(7):1230-1236. doi: 10.1377/hlthaff.2015.1661.

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