Veterans’ access to medicinal cannabis: Applying to the DVA

02 August 2023

The Department of Veteran Affairs (DVA) accepts applications from veterans to fund medicinal cannabis treatment for many conditions. Strict eligibility criteria apply, and a defined process must be followed – but recent updates have made this easier for veterans.

Written by: Dr Natalie J. Beveridge (PhD (Pharmacology), BBiotech (Hons))

Access to medicinal cannabis for veterans

All veterans may access medicinal cannabis in the same way as the general population – via medical consultation and private full-fee prescriptions. For veterans that may be eligible for DVA subsidies, the process has recently become easier in many circumstances. The Department of Veteran Affairs (DVA) accepts applications from veterans to fund medicinal cannabis treatment for many conditions. Strict eligibility criteria apply, and a defined process must be followed – but recent updates have made this easier for veterans.

The DVA will consider requests for funding on a case-by-case basis. A limited number of pre-specified conditions allow for an easier, streamlined application to the DVA, and others must follow a longer, more comprehensive application process. Regardless of the condition, it is important to note that the DVA will only reimburse costs following the approval, purchase, and commencement of treatment – the DVA does not provide funding upfront.

Consultations

In most circumstances, the fees for the first medicinal cannabis consultation are not eligible for reimbursement, though each subsequent consultation is usually fully covered.

Any GP can prescribe medicinal cannabis in Australia, (except for Tasmania where you need a specialist). To be eligible for a prescription, some key criteria apply.

1. Do you have a chronic medical condition/s that might be treated by cannabis?

2. Have you tried other treatments for your medical condition(s)?

3. Have those treatments ‘failed’ to provide relief of symptoms or created undesirable side effects?

The most common pathway for treating doctors to prescribe medicinal cannabis products is the Therapeutic Goods Administration’s (TGA) Special Access Scheme B (SAS-B). Alternatively, if they are an Authorised Prescriber, they may be able to issue a prescription on the spot.

The DVA’s medicinal cannabis framework

Medicinal cannabis is funded through the Repatriation Pharmaceutical Benefits Scheme (RPBS). There is a two-tiered process for applying for medicinal cannabis to be funded through the RPBS (Table 1).

The DVA will only consider funding medicinal cannabis treatment for chronic conditions (persisting longer than 3 months) and after standard treatments have not been successful.

The DVA will accept Tier 1 applications to fund treatment of the following health conditions without requesting additional evidence of its effectiveness for:

chronic pain
chemotherapy-induced nausea and vomiting (CINV)
palliative care
anorexia and wasting associated with chronic illness, such as cancer
spasticity from neurological conditions, such as multiple sclerosis
refractory paediatric epilepsy

Other conditions may also be considered but require more information from the treating doctor(s) will need to be provided in a Tier 2 application.

The DVA will not approve medicinal cannabis funding for conditions where its use has not been proven to be effective, harmless and safe – such as treatment for a mental health condition.

Tier 1

If a request meets all three criteria regarding number of medicinal cannabis products, total THC content and the medical condition – the treating doctor may apply for DVA approval over the phone by calling the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) on 1800 552 580.

Tier 2

Tier 2 requests require the completion of an application form and letter from a relevant non-GP specialist confirming that medicinal cannabis would be of clinical benefit.

A specialist is defined as a medical specialist in the area of the condition being applied for (e.g. a pain specialist, orthopaedic surgeon, vascular surgeon). If the prescribing doctor is a specialist, they may complete the specialist assessment themselves.

The letter from the specialist must confirm that:

they have advised you of potential contraindications
they have undertaken a suicide and mental health assessment (and determined there is no increased risk from medicinal cannabis on suicide ideation or your mental health)
there is no current substance use and are considered low-risk for developing a substance use disorder

substance use disorder

Applying to the DVA

For Tier 1 applications, prescribing doctors will call the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) on 1800 552 580.

For Tier 2 applications, prescribing doctors will complete the Form D9403 Medicinal Cannabis Tier 2 Application available from https://www.dva.gov.au/about-us/dva-forms/medicinal-cannabis-tier-2-application. This, together with the supporting letter from the specialist can be sent to PPO@dva.gov.au.

What happens next?

Once applications are received by the DVA, how they are processed depends on the medical condition.

For the pre-specified conditions of chronic pain, CINV, palliative care, anorexia/wasting, spasticity, or paediatric epilepsy – a pharmacist reviews the application.

If they are satisfied that the doctor and specialist have provided all necessary information, then an approval letter will be forwarded to the prescribing doctor.

The pharmacist will contact the prescribing doctor if any further detail or information is required.

For other health conditions not listed in the pre-specified category – applications are sent to a DVA-appointed specialist.

This specialist reviews of the documentation and may ask for more information from your doctor in the form of validated questionnaires or a more detailed monitoring plan.

Approvals are only granted for a fixed duration (usually 3 or 6 months). To extend funding beyond this, the prescribing doctor will need to submit a clinical report to the DVA.

You’re approved

Once approved – the prescribing doctor will be notified, and they will arrange an authority prescription. This can be taken to any pharmacy that dispenses RPBS prescriptions (nearly all community pharmacies can dispense RPBS items).

A concessional co-payment will need to be paid to the pharmacy each time the medicinal cannabis product is dispensed – unless the patient has reached the concessional safety net limit (meaning no further cost) for the calendar year.

The DVA continues to actively monitor research in the medicinal cannabis space to ensure decisions about funding medicinal cannabis are informed by the latest clinical evidence – ensuring the best possible outcomes for veterans.

The DVA’s Framework is consistent with the opinion of Australian professional medical bodies and is aligned with current clinical evidence. The recent updates provide greater flexibility for the DVA to adapt and include more health conditions in the future, as clinical evidence emerges.

More information regarding veterans’ access to medicinal cannabis treatment is provided on the Department of Veteran Affairs website at https://www.dva.gov.au/providers/health-programs-and-services-our-clients/medicines/medicinal-cannabis-information. This information was correct at the time of writing, 26^th July, 2023.

Source material

Simplified process for DVA funding of medicinal cannabis. DVA Provider News article. Published 16 January 2023. https://www.dva.gov.au/providers/provider-news/simplified-process-dva-funding-medicinal-cannabis. Accessed 10 July 2023.

Medicinal cannabis for veterans. Department of Veterans’ Affairs, Australian Government. Published 16 January 2023. https://www.dva.gov.au/get-support/health-support/help-cover-healthcare-costs/manage-medicine-and-keep-costs-down-0. Accessed 10 July 2023.

Medicinal cannabis for providers. Department of Veterans’ Affairs, Australian Government. Published 16 January 2023. https://www.dva.gov.au/providers/health-programs-and-services-our-clients/medicines/medicinal-cannabis-information. Accessed 10 July 2023.

Medicinal Cannabis Tier 2 Application. Department of Veterans’ Affairs, Australian Government. https://www.dva.gov.au/about-us/dva-forms/medicinal-cannabis-tier-2-application. Accessed 10 July 2023.

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