Medicare dips a toe into hemp for seniors

• Policy experts say it also taps into public dissatisfaction with how the health system treats chronic pain and other health problems.
• "There is a flavor here of, 'We as a society, across the political spectrum, are not happy with the options that we have available to us,'" said Edo Banach, co-chair of the health care department at the law firm Foley Hoag.

How it works: In certain payment arrangements, Medicare providers can get reimbursed as much as $500 per patient each year to discuss and provide certain CBD products.

• Providers have to front the cost and can't instruct seniors to buy their own products.
• Any CBD solutions can't exceed concentrations of 0.3% of delta-9 THC, the main psychoactive ingredient in cannabis, or more than 3 milligrams of THC per serving.
• They also must be tested by a third party and meet state and local standards. The program excludes patients who have certain medical conditions, including substance use disorder and COPD.

Between the lines: Marijuana is subject to a patchwork of standards. Even though most states have legalized medical marijuana and about half allow recreational use, the substance remains illegal at the federal level.

• President Trump's rescheduling push wouldn't legalize it.
• Last week, Food and Drug Administration commissioner Marty Makary stipulated in a memo that his agency won't enforce prohibitions on oral CBD products that are eligible under the Medicare program.

Zoom out: Seniors who are already using cannabis products for pain, insomnia and a variety of ailments usually do so without guidance from health care providers.

• That raises concerns about interactions with other drugs and inappropriate dosing, said Leigh Vinocur, chief medical adviser for National Compassionate Care Council, a medical marijuana advocacy group.
• "Right now, seniors are muddling their way through it themselves," she said. "This program, at least, will give us some guidelines when we look at it."
• The pilot will generate "important insights into how providers can use these tools safely and effectively in real-world care settings," Centers for Medicare and Medicaid Services administrator Mehmet Oz said in a statement.

Yes, but: Anti-marijuana groups are suing to halt the program, arguing the administration violated administrative law by creating it, and that the effort endangers seniors' health and safety.

• "CMS's action represents an unprecedented and unlawful assertion of binding decision-making authority that will profoundly affect the health of elderly Americans," the lawsuit from Smart Approaches to Marijuana and 10 other plaintiffs states.

Reality check: The fact that providers will have to pay for the hemp products themselves could lead to low participation in the test program, Foley Hoag's Banach said.

• "There's a bit of a disconnect about the goals here and the way that those goals are actually going to be accomplished, unless something changes in federal law," Banach said.
• Still, "when participation is low, that doesn't mean it's a failure, it doesn't mean it's not a good idea. It just means not yet," he added.

What we're watching: A law due to take effect in November will change the legal definition of hemp, re-criminalizing many substances in the category that Congress in 2018 declared were not controlled substances.

• CMS says it'll adjust limits on hemp products offered in the Medicare pilot program as the law changes.