Lawsuit seeks full insurance coverage for behavioral health cannabis use
Jun. 14—The state's largest licensed cannabis producer has filed a lawsuit that asks a district court to order health insurers to cover the cost of medical cannabis for New Mexico patients who use it for behavioral health conditions.
Ultra Health President Duke Rodriguez has sued the state over plant counts, purchase limits and the number of dispensaries his company is allowed to have but said Monday his most recent lawsuit is the most significant he or anyone in the industry has filed in the past decade.
The basis for the argument is a 2021 New Mexico law which prohibits insurers from requiring patients to share the cost of medications prescribed for mental or behavioral health needs. It requires the insurance company to cover the entire cost of such medications without a co-pay.
The law took effect in 2022.
In addition to seeking a declaration that cannabis should be 100 percent covered by any company offering insurance in New Mexico as a medically necessary behavioral/mental health service, the class action lawsuit seeks damages on behalf of six named plaintiffs and others like them who so far have been covering all the cost for marijuana they take to treat mental health conditions.
The complaint — filed Friday in state District Court in Bernalillo County — also seeks "disgorgement of the millions of dollars in excess profits and revenues retained by the defendants" via an award of an unspecified amount of punitive damages to be determined by a jury.
The six named plaintiffs include state Sen. Jacob Candelaria, D-Albuquerque, and four other medical cannabis patients who, like the lawmaker, use cannabis to treat symptoms of post-traumatic stress disorder.
A Sandoval County father whose child with non-verbal autism was one of the first pediatric patients enrolled in the state's medical cannabis program also is a plaintiff.
Rodriguez estimated Monday about 55 percent of the patients enrolled in the state's Medical Cannabis Program — or about 74,000 people — qualify to use medical cannabis at least in part on the basis of a diagnosis of post-traumatic stress disorder.
Rodriguez said the state Regulation and Licensing Division has reported medical cannabis sales have been about 17.5 million per month in recent months, meaning potential damages on behalf of patients could be somewhere in the range of $10 million per month since January.
Seven major medical insurers are named as defendants in the case, including Blue Cross and Blue Shield of New Mexico; Cigna Health and Life Insurance Company; True Health New Mexico; Molina Healthcare of New Mexico; Presbyterian Health Plan; Presbyterian Insurance Company; and Western Sky Community Care.
The New Mexican contacted all the defendants. Only Presbyterian Health, Western Sky Community Care and True Health New Mexico responded; all three declined to comment on the pending litigation.
"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," Rodriguez wrote in a news release announcing the filing of the litigation. "Revolutionizing behavioral healthcare in New Mexico will take only a few small steps, rather than a giant leap."
