Marijuana is still a Schedule I controlled substance under federal law, and the passage of Prop 64 by California voters will not change that. Nevertheless, the legalization of cannabis for recreational purposes is likely to remove some of the stigma around weed in general, which may make doctors more open to its use in conditions that aren't currently on the list.
At some point, marijuana could be routinely prescribed and part of most health insurers' formularies. In the not-too-distant future, marijuana might be a treatment injured workers expect to be covered by workers' comp, according to a recent white paper by the California Workers' Compensation Institute. It hasn't happened yet, but insurance companies need to start thinking ahead.
Considering the apparent shift in public attitudes toward marijuana, it's entirely possible that the federal government could decriminalize it, or at least refrain from any further prosecution in states where it's legal. Moreover, if the federal limitations on cannabis research were lifted, new research could point to an expanded list of conditions for which the drug could be effective.
Claims administrators should begin establishing standards of review for treatment and payment requests now. At the same time, the fact that marijuana is illegal is still important. Some companies will terminate any employee caught using pot, even if it's medically approved. That means your new policies will need to take into account the impact of California's medical privacy laws and any potential conflicts with the Employer's Bill of Rights.
Before you decide not to cover medical marijuana even if it becomes legal to do so, consider the possibility that new research may show it, or a pharmaceutical derived from it, holds real promise as a replacement for opioid pain relievers.
Under current law, insurers cannot be required to pay for marijuana, even when it has been prescribed by a doctor for legitimate medical treatment. If that changes, the advantage will go to the players who get sound legal counsel and put plans in place well in advance.