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By Ed Mahon | Spotlight PA
A proposal being considered in the state legislature would eliminate an unusual restriction in Pennsylvania that bans doctors from advertising their ability to approve patients for the state’s medical marijuana program.
Several medical marijuana advocates, patients, and doctors welcomed the idea, saying it would create a fairer system. Currently, large third-party companies — which offer to connect patients to doctors — are free to promote themselves on the radio, run newspaper ads, offer discounts on sites like Groupon, dominate Google searches, and put up signs on the side of roads. The advertising disparity was the subject of a Spotlight PA investigation last year.
But some supporters of medical marijuana raised concerns about other aspects of the bipartisan bill, which would represent a major update to the state’s medical marijuana law. The bill would allow doctors to approve patients for any medical condition — instead of one of 24 approved conditions — and eliminate a requirement that patients renew their card once a year.
“It’s not going to be medical any more,” said Lauren Vrabel, a cannabis pharmacist from Allegheny County and representative of the group Doctors for Cannabis Regulation. “This bill looks like an adult-use bill.”
The sponsors of the bill have argued the changes are needed to improve the medical marijuana program and prevent Pennsylvania residents from traveling to neighboring states that have legalized adult-use marijuana. During a committee hearing, state Sen. Mike Regan (R., York), one of the bill’s sponsors, said the update to the law would respond to “problems with the medical marijuana program and the restrictive and inconsistent oversight by the Department of Health.”
“The ultimate goal is to reduce restrictions on medical marijuana organizations and to reduce the cost and burden on patients,” Regan added.
Four neighboring states — Delaware, Maryland, New Jersey, and New York — have approved cannabis for all adults 21 and over. In Pennsylvania, Democratic Gov. Josh Shapiro proposed a tax on adult-use cannabis in his budget package, but neither chamber in the legislature has passed an adult-use legalization bill this session. Regan — who held a series of legislative hearings last year on adult-use legalization — is one of the few Republican legislators in Pennsylvania to endorse ending the prohibition.
For now, patients need a doctor’s approval to legally buy cannabis in the state, and that would remain the same under the bill from Regan and state Sen. James Brewster (D., Allegheny).
A spokesperson for Senate Majority Leader Joe Pittman (R., Indiana) declined to say when and if the full Senate would consider the bill for final passage, saying only that discussions are taking place. If it passed the Senate, it would still need to clear the state House before reaching the governor. The Shapiro administration declined to say whether it supports the proposal.
New bill would eliminate doc ad ban
The legislative action follows a series of investigative stories from Spotlight PA that found serious flaws in the state’s medical marijuana program.
The state’s advertising ban on medical marijuana doctors was the subject of a 2022 Spotlight PA investigation that found that the restriction and its inconsistent enforcement gave an advantage to largely unregulated certification businesses that stand to rake in millions of dollars each year through courting Pennsylvania medical marijuana patients. Those companies offer to connect patients to doctors, sometimes offering money-back guarantees if doctors don’t give approval.
Of Pennsylvania’s neighbors, only West Virginia had a similar advertising ban for health care professionals, the investigation found, but regulators there had a more lenient interpretation of what certifying physicians could say online.
In Pennsylvania, individual physicians working on their own or in small practices can face harsh penalties for buying ads — or even for simply noting on websites that they are among the state-approved physicians who can certify patients for medical marijuana cards, Spotlight PA’s investigation found. The restriction was one of several that lawmakers added to the bill when they legalized medical marijuana in 2016.
Under the bill that recently passed out of the state Senate Law and Justice Committee with a 10-1 vote, Pennsylvania would entirely eliminate that advertising restriction. Allowing doctors to advertise would help “level the playing field,” Brewster told Spotlight PA.
The change makes sense to Steven Evans, a Berks County pain management physician and one of the state’s approved medical marijuana doctors.
“If companies can do it — and all they’re doing is they’re just like a shell and underneath of it are all these doctors who are doing all these certifications — why not just let the doctors do it?” Evans told Spotlight PA.
The bill does not propose any new oversight for third-party certification companies. While individual doctors would likely be unable to spend as much as large companies on advertising, the proposed change in state law would allow them to get their name out without fear of being disciplined by the Department of Health or even having their medical license threatened, several doctors and patient advocates told Spotlight PA.
If the measure became law, Evans said he would probably “put a little blurb in the newspaper” that notes his practice offers medical marijuana consults and certifications.
“I’m not going to be like buying a full page ad with a big green marijuana leaf on it, and my face is in the middle of it,” Evans said. “No, that’s kind of nuts.”
But he figures some people probably will.
Fewer patient requirements
One of the bill’s most consequential proposals is to jettison the annual requirement for patients to renew their medical marijuana card. But some doctors and patient advocates told Spotlight PA they’re concerned this change would lead to patients consulting with doctors less often.
Currently, those medical marijuana cards are closely connected to certifications from doctors. The Department of Health requires patients to receive a new certification from a doctor before they renew their card. The department regulations state that each certification from a doctor must include a “statement as to the length of time, not to exceed 1 year, for which the practitioner believes the use of medical marijuana by the patient would be therapeutic or palliative.”
But Regan’s chief of staff, Bruce McLanahan, told Spotlight PA the intention is to end the requirement that patients receive a certification at least once a year — a change that would affect each of the hundreds of thousands of patients and the roughly 1,800 physicians who can approve them for the program.
Renewing a card costs $50, which has to be paid to the state unless people qualify for a waiver. But the annual recertifications can typically cost patients around $100 to $200 that they pay to doctors or companies that work with the doctors.
“We’ve heard from patients that the process is burdensome,” McLanahan told Spotlight PA.
But he acknowledged that the senators’ proposal and the current law do not specifically address the time period of certifications, stating in an email that “the Department has taken it upon themselves to impose an annual certification renewal.” Brewster and Regan’s bill doesn’t guarantee regulators would alter the certification time period.
The bill would still require patients to be under a doctor’s “continuing care” — a criteria that doesn’t define how frequently doctors must see patients. Doctors would also have a responsibility to immediately notify the department if they choose “to no longer certify an individual,” the bill states.
Several doctors, including Lehigh County physician Charles Harris, told Spotlight PA they’re concerned that if the bill passes, some physicians would approve patients and not provide oversight afterward.
“My status would go from that of a revered and knowledgeable medical specialty consultant to more of a doorman at a nightclub,” Harris said in an email. “Once you have paid the cover charge and gotten your hand stamped you are good to go.”
How long certifications should last has been a point of contention before.
In March 2022, the state’s Medical Marijuana Advisory Board rejected a plan from its patient and caregiver subcommittee that proposed increasing the standard maximum time for certifications from one year to two years and allowing lifetime certifications for patients with terminal or chronic qualifying medical conditions, among other suggestions.
“Isn’t there a necessity to do some reevaluation of individuals to recertify them?” said Denise Johnson, the state’s physician general at the time. “Two years seems like an awfully long time in between that.”
When asked about annual certifications and oversight of patients, Brewster told Spotlight PA the legislation could and likely would still change.
“Some of the things you brought up could come up in an amendment, make the bill better,” he said. “I wouldn’t think the bill would go through clean.”
The bill would also change the program in other ways, including loosening a variety of restrictions on dispensaries and growers, requiring the director of the Office of Medical Marijuana to receive state Senate confirmation, and lifting a ban on smoking medical marijuana.
Jeff Hanley, executive director of the Commonwealth Prevention Alliance, which opposes adult-use cannabis legalization, said he’s concerned about expanded access in this bill, including allowing doctors to approve patients for any condition.
But he had a nuanced position about lifting the advertising ban on doctors. Though he’s concerned about what the content of the advertising will be, he said allowing doctors to advertise is better than the current system in which only companies can.
“I think that’s wrong. I think it’s disingenuous,” Hanley told Spotlight PA. “And I think having something like this is probably the lesser of the two evils, that’s for sure.”
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