Utah’s QMP Program Creates Major RoadBlock for Patients
by MADELINE FERGUSON
Barriers for equitable access to healthcare come up for many Americans at least once, most likely more, in their lifetime. It seems our medical cannabis program in Utah is no exception to this premise either. While no state program is perfect, ours has several hurdles that should be reexamined to open up these barriers to entry. Cost, reasonable accessibility, and product quality are of significant importance for patients regarding plant medicine. We’ll be covering the topic of cost and accessibility for this article.
Let’s walk through the process...
QMP’s prescription requirement
To gain access to legal cannabis in Utah, a patient must acquire a prescription from a Qualified Medical Provider (QMP) or Limited Medical Provider (LMP).
What’s a QMP? They are medical professionals that have taken the state’s required four-hour training and paid a small state fee to prescribe cannabis to patients. Worth noting, in comparison, no additional training is necessary for a doctor or other professionals to prescribe most pharmaceuticals. Usually, a 15 min conversation with a drug rep and a doctor can prescribe. So, the state does recognize the years of medical schooling and training required to become a qualified medical professional that can prescribe.
Dr. Andrew Talbott, a Park City anesthesiologist and pain specialist, explains why he isn’t comfortable with the program’s design.
“I am concerned about the position in which the Utah Legislature has put physicians.”
He explains, “Cannabis is, of course, federally illegal, and it’s a schedule I substance. The QMP system requires that a prescription for cannabis be provided, which goes against the agreement that any provider prescribing controlled substances makes with the DEA (who gives the licenses).
Talbott adds, “I can not risk losing my DEA license and still care for the majority of my chronic pain patients. Inexplicably the legislature has also required that a DEA Controlled Substances license be held by all QMPs, creating a Catch-22 where the act of prescribing the cannabis puts the QMP at risk of losing their ability; to prescribe it again lawfully.”
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In an attempt to get more doctors interested in participating in the program, Senator Luz Escamilla passed a law earlier this year granting all doctors the ability to recommend up to 15 of their patient’s cannabis without registering to become QMP. However, the UDOH was unable to meet the deadline to implement that addition to the law. With many moving parts to the program, many feel this is a red herring and not the best solution to correct the lack of physician participation.
Dr. Talbott offered a solution, “Ideally, I would like to see the superfluous QMP system removed and replaced by a process in which patients simply have a recommendation from their physician, stating that they have been diagnosed with a qualifying condition and may benefit from cannabis. The patient could then take that recommendation to the state, certifying them and providing their card. There is no reason that we need to have special, expensive clinics focusing on providing patient access to cannabis.”
Dissolution of the QMP program seems like a viable approach; doctors would be more apt to recommend it since it removes the federal threat of DEA entanglements.
It may seem like the state is being cautious by insisting on a QMP program with patient caps on doctors prescribing. However, when we examine the facts about cannabis and pharmaceuticals side by side, the latter is the actual cause of public safety concerns. There are no reported overdose deaths caused by cannabis consumption in all of human history. In contrast, according to the CDC (Nov 2021, report), there were an estimated 100,306 drug overdose deaths in the past 12 months, most from synthetic opioids. So why the over-the-top protocol?
Begs the question, what is the QMP program accomplishing?
Many patients in Utah are priced out because of the cost of entry, not to mention how expensive their medicine is once they are in the program. Initial fees are upwards of $225 plus the state card fee of $15. That’s for the first 90 days. Then a renewal at 90 days with a QMP fee runs about $100-175 and state fee of $5 and then every six months for another $100-$175 in cost, plus the state fee. So you are looking at $35 in-state fees, which is fantastic compared to other states. But the QMP fee runs between $425-600 dollars a year. If your card expires, you have to start all over again as a new patient. Those prices are sure to keep many low-income people out of the program and on the legacy market.
On top of the price, requiring patients to renew so often puts even more financial stress on people in addition to the time commitment. When patients have to renew so often, that is forcing them to take time off work, find a babysitter and rearrange a day of their lives every six months for what is effectively a use tax. This all seems like unnecessary hoop-jumping for compassionate access.
It is reported that the appointments or consultations with some QMP’s to obtain a card last as little as ten minutes. Nearly $200 for ten minutes? These paper mills aren’t a place for patients to get help with their condition or medical advice; they simply serve the purpose of giving patients with an ALREADY diagnosed condition access to the program. It feels like a “user tax” industry has been created.
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If a primary care doctor can write you a prescription, why wouldn’t they be able to take care of recommendations? That’s a question many patient advocates would like an answer to.
“The LMP and QMP programs created exactly what legislators claimed they were trying to prevent. The legislature has created a predatory breeding ground for cannabis paper mills and ‘pot docs,’” TRUCE (Together For Responsible Use And Cannabis Education), discussed the issue in a Facebook post. Requiring patients to see a QMP rather than just their primary care provider overcomplicates the process and makes it way too expensive.
Adding to the issue of requiring patients to see a QMP is the patient cap rule. This stipulation limits how many patients physicians can recommend cannabis to; according to TRUCE, it creates a lottery system where doctors have to ration out care. This is the reason paper mills have sprung up. Between prescribing requirements and patient caps, the predatory practices of paper mills continue. The patient cap rule seems to be yet another place where legislators have created an environment here in Utah that disenfranchises the patients.
The end of prohibition is messy and complicated, but positive change can be made along the way through continued dialogue and advocacy for patients.