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Yesterday, the public comment period closed on a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that could reshape how some cannabis therapies are treated under Medicare. For millions of patients, this is a major milestone. It signals that federal agencies are finally beginning to acknowledge what patients and clinicians have long known: cannabis has legitimate medical value.

Americans for Safe Access (ASA) submitted comments on behalf of current and future medical cannabis patients who stand to be directly affected by this policy. Read ASA's public comments. 

But it also exposes a deeper failure.

Without comprehensive federal legislation, even well-intentioned reforms will continue to fall short—and vulnerable patients will remain trapped in legal and financial limbo.

For years, Medicare regulations flatly prohibited “cannabis products,” regardless of medical use or state legality. CMS now proposes limiting that prohibition only to products that are illegal under applicable state or federal law. That change reflects an overdue recognition that federal policy cannot ignore science, state medical programs, and patient experience.

In our public comments, Americans for Safe Access (ASA) emphasized that “for terminally ill Medicare beneficiaries—people living with advanced cancer, neurodegenerative disease, end-stage organ failure, and other life-limiting conditions—this change is not abstract policy.” It “determines whether they can access therapies that relieve pain, nausea, anorexia, spasticity, anxiety, and insomnia when conventional treatments fail or cause intolerable harm.”

Despite growing scientific consensus, federal policy has long treated cannabis as incompatible with healthcare programs. As ASA warned, “a blanket prohibition on all ‘Cannabis products’ denies these patients lawful, evidence-supported options at the very moment when comfort, dignity, and symptom control matter most.”

This disconnect is especially dangerous for older and medically fragile patients. Nearly half of adults over 65 take five or more prescription medications, placing them at high risk of dangerous drug interactions. Thousands are hospitalized each year because of medication-related harm. At the same time, major scientific reviews have recognized cannabis’ therapeutic value for chronic pain, chemotherapy-related nausea, spasticity, and sleep disorders. Studies consistently show that patients who use medical cannabis often reduce their reliance on opioids, sedatives, and sleep medications.

ASA highlighted a critical distinction: “Cannabinoid therapies offer a fundamentally different safety profile.” Unlike opioids and sedatives, “cannabinoid receptors do not regulate respiratory or cardiac function, making fatal overdose biologically implausible.”

Yet under existing Medicare rules, even lawful, physician-recommended cannabis therapies remain excluded. As ASA explained, “this categorical exclusion substitutes stigma for science and deprives patients of lawful options at the end of life.”

The financial consequences are equally severe. Without insurance coverage, patients must absorb the full cost of their treatment. “Without Medicare coverage,” ASA noted, “patients who rely on cannabinoid therapies must currently pay entirely out of pocket—often $150–$400 per month or more.”

At the same time, many of these patients continue paying copays for opioids, sedatives, and other medications that cannabis could partially replace. This creates a perverse incentive system that pushes patients toward higher-risk pharmaceuticals simply because they are reimbursed.

As ASA warned, “a categorical ban on lawful cannabinoid therapies forces patients into higher-risk, higher-cost care pathways.”

CMS deserves credit for acknowledging this problem and attempting to correct it. The proposed rule restores some coherence to federal policy by allowing Medicare Advantage plans to evaluate cannabis therapies under the same standards applied to other supplemental benefits.

But regulatory fixes cannot overcome structural barriers created by federal prohibition.

Patients in hospice, assisted living, nursing homes, and long-term care facilities are still routinely denied access. Providers remain constrained by legal uncertainty. Facilities fear losing federal funding. Families are left watching loved ones suffer unnecessarily.

Federal agencies are being asked to solve a problem that only Congress can fix.

CMS cannot rewrite the federal drug law. Neither can executive orders. Only Congress can create a durable, national medical cannabis framework that integrates cannabis into healthcare, research, insurance, and provider education.

For more than a decade, lawmakers have relied on temporary fixes and regulatory workarounds. The result is a fragmented system in which patient access depends on geography, income, and institutional risk tolerance rather than medical need.

ASA made clear what is at stake: “For terminally ill Medicare beneficiaries, every day of unmanaged pain matters. Every preventable hospitalization matters. Every opportunity to preserve dignity matters.”

Without comprehensive reform, patients will continue to experience fragmented and unequal treatment across federal programs. The closing of this comment period is not the end of the conversation. It is the next test of political will. CMS has acknowledged the issue. Patients have documented the impact.

Now Congress must act.

Medical cannabis is not a fringe issue. It is part of modern healthcare. It helps patients manage chronic pain, cancer-related symptoms, neurological conditions, and complex illnesses when conventional treatments fail or cause harm. It reduces reliance on high-risk pharmaceuticals. It improves quality of life.

Federal law must finally reflect that reality.

Until it does, reforms like this one will remain well-intentioned but insufficient. Seniors will continue facing dangerous polypharmacy. Families will continue watching loved ones denied relief in care facilities. Patients will continue paying out of pocket for medicine that helps them function and survive.

CMS is beginning to catch up to patients. Now Congress must follow by passing comprehensive federal legislation that creates a national medical cannabis framework and turns good intentions into real access.