Up in smoke: One state's perspective on the affordability of medical cannabis.

ABSTRACT

BACKGROUND: Minnesota's medical cannabis program has been praised for being one of the most regulated in the nation. Currently, its use is limited, with one of the reasons being affordability. SUMMARY: In Minnesota, patients pay an annual enrollment fee of up to $200, and the cost of the actual product can range from $30 to $300 per unit of sale, which can be compounded by increased dosing frequency or the need for several routes of administration. Between 2017 and 2018, 49.5% of patients enrolled in the medical cannabis program did not renew their enrollment. Although data regarding the reasons for discontinuation are not available, it is reasonable to suspect that cost played a role in some of these patients. In a small survey conducted by the Minnesota Office of Medical Cannabis, cost of product was rated a common reason for uncertainty regarding re-enrollment in the program. Another issue that may also limit the affordability of cannabis in Minnesota is lack of competition. Outside the Minneapolis-St. Paul metropolitan area, the 2 medical cannabis manufacturers are able to operate free from competition, leaving patients with the option to either use that 1 manufacturer or obtain product by illicit means. CONCLUSION: Nationally, to increase the usability and affordability of medical cannabis, pharmacists should advocate for the relaxation of its controlled substance status. A relaxed status has the potential to increase provider and patient acceptability as well as patient access. In addition, it would allow more research to take place to determine the therapeutic role of cannabis. Finally, it would open the door for prescription drug coverage, which is not without its barriers on a national level. In the meantime, pharmacists in Minnesota should advocate for additional approval of evidence-based indications and an increased number of manufacturers. These changes could increase demand and competition for medical cannabis and drive down prices.