Medical marijuana is now legal in 18 states and the District of Columbia, but health insurance doesn't cover it and patients often scramble to cover the cost.
"It's an expensive medication, no doubt about it," says Kris Hermes, a spokesman for Americans for Safe Access, a patient advocacy group. "Patients are struggling to afford it, regardless of whether it's available in their state."
Hermes estimates that patients pay $20 to $60 for an eighth of an ounce, enough to make about three joints. For someone who only needs a few hits a day to manage pain or nausea or to stimulate their appetite, that may not be a big burden. But many people need much more than that, he says.
Recognizing this problem, some state marijuana dispensaries offer discounts to patients with low incomes.
Other states reduce the fee sometimes as high as $200 that patients in many states must pay to register with the state as a medical marijuana user with a qualifying medical condition.
Massachusetts, the most recent state to pass a medical marijuana law in November, will allow people who are facing financial hardship to cultivate their own 60-day supply.
That's more restrictive than many state laws, which permit patients to grow their own plants whether or not they're strapped financially, says Karen O'Keefe, director of state policies for the Marijuana Policy Project, an advocacy group.
"For some people with long-term conditions like multiple sclerosis, this is the best option," she says.
Of course, many people using medical marijuana would rather have insurance coverage. But as long as marijuana remains classified as a Schedule 1 substance under the Controlled Substances Act meaning it has no medical use and a high potential for abuse that's unlikely to happen, says Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade group.
It's a federal crime to use marijuana, even in states that permit it for medicinal purposes, she says. And employers and health plans want to see stronger scientific evidence that marijuana is as safe and effective as other drugs to treat pain or nausea, for example, before they cover it.