One question keeps coming up among patients in the medical community: why is the cost of getting certified for medical marijuana (MMJ) so different from doctor to doctor?

The Basics

While a portion of the costs may certainly be up to the doctor themselves or the company/practice they’re working at, some other factors that may contribute to the cost are the level of care provided, whether they provide IT assistance, and the risk associated with MMJ. Before we take a look at the factors that influence the cost of MMJ certification, let’s take a quick look at what doctors (or other registered practitioners) are legally required to do before they certify you for MMJ.

Legal Requirements

First, the doctor must ensure you qualify for treatment with MMJ by making sure you have a qualifying diagnosis documented in your medical chart. The list of qualifying conditions for MMJ in NY can be found here. The doctor must also rule out any contraindications to MMJ. This just means they make sure you don’t have any conditions that would preclude the use of MMJ. The jury is still out regarding which conditions should avoid the use of MMJ, but one that is heavily agreed upon is any history of psychosis or a first degree relative with psychosis. Other potential contraindications may include severe kidney or liver disease, or an allergy to cannabis. Doctors are also required to discuss the risks and benefits of MMJ with you and must document it in your medical chart. Doctors are required to check the State’s prescription monitoring program and review your controlled substance purchase history (MMJ is treated as a controlled substance in NY). After completing the steps above, in no particular order, the doctor can then certify you for MMJ.

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IT assistance

The actual process of certifying you for MMJ is done online through the State’s Health Commerce website. The state developed its own system for managing medical marijuana “e-prescribing” called the Medical Marijuana Data Management System or MMDMS for short. It can be quite a pain to work with; the MMDMS definitely wasn’t designed by the guys at Google. After you get certified for MMJ, you can’t get up and go to a dispensary right away, you’ll have to set up a patient account through MMDMS and complete a form confirming your address and DMV photo are up to date. After you do this, you’ll receive a temporary card that will allow you to pick up MMJ while waiting for your official card to come in the mail. Some doctors or their staff will help you get set up with an account and a temporary card. Doctors that offer this service may charge an additional “IT” Fee. Not all doctors will do this and some may do it without charging extra, but it does require more work and time from the doctor or their staff.

Level of Care

Level of care refers to the amount of effort that is required by your doctor to take care of you. If you have more than one condition or take more than a few medications, then this usually means it will take more time to treat you effectively and safely. Many patients seeking treatment with MMJ have very complex medical situations as they often turn to MMJ as a last resort. Some doctors charge as low as $150 for certifying you for one year  This is really just a transactional process, you pay a fee, and if you qualify, you’re certified and are able to purchase MMJ from a dispensary. There is really no “care” involved at all. Other doctors charge up to $300 every few months. These doctors aren’t necessarily taking advantage of you, as long as they provide you with a higher level of care or additional services in return. For instance, some doctors will work directly with their patients to find them affordable products as well as an individualized dosage form and dose of THC/CBD. Patients using MMJ frequently complain of being unable to focus or that they feel “foggy”. Some doctors will help their patients achieve symptom relief and avoid certain unwanted side effects by adjusting their dose of THC or CBD. Some doctors even provide advice on how to taper off other medications such as benzodiazepines and opioids. Surely, this level of care requires more time and effort from the doctor and, thus can arguably be compensated as such.

Risk

MMJ is not an FDA approved medication. Doctors and other providers choosing to recommend MMJ are taking a substantial risk as they may increase their exposure to litigation if a patient were to experience an adverse effect as a result of MMJ (and the doc did not adequately warn the patient of this effect). Most people think MMJ is harmless, but adverse effects do occur more frequently than you’d think. In Colorado, where cannabis is recreationally legal, an individual killed himself by jumping off a building while intoxicated from an edible. If that were to happen in NY, from an MMJ product, the patient’s family might pursue litigation against the doctor that certified their daughter or son. For this reason, some doctors may feel they need to be compensated more for taking this risk.

Think MMJ is Right for You?

If you think MMJ is right for you, there are a number of providers in the Buffalo Niagara region that can help you come to that conclusion. Here is a curated list of doctors in the area that will prescribe MMJ in the right situations. Cannabuff also provides a list here of registered dispensaries that provide some of the best MMJ products available in the state.