Minnesota Department of Health Office of Medical Cannabis Report on Medical Cannabis Price Study Version 1.2 Submitted by: Bill Brown, Principal Yoko McCarthy, Manager BerryDunn 2211 Congress Street Portland, ME 04102 Table of Contents Table of Contents ......................................................................................................................... i 1.0 Introduction .......................................................................................................................... 1 1.1 Project Background .......................................................................................................... 1 1.2 Office of Medical Cannabis (OMC) ................................................................................... 2 1.3 Registered Medical Cannabis Manufacturers.................................................................... 2 1.4 Products Offered in Minnesota and Definitions ................................................................. 3 2.0 Purpose and Scope .............................................................................................................. 4 2.1 Purpose ............................................................................................................................ 4 2.2 Scope ............................................................................................................................... 4 3.0 Results ................................................................................................................................. 6 3.1 Minnesota Medical Cannabis Price Study ......................................................................... 6 3.1.1 Current Medicine Price List – LeafLine ....................................................................... 6 3.1.2 Current Medicine Price List – MinnMed ...................................................................... 8 3.2 Medical Cannabis Price Comparison ...............................................................................11 3.2.1 Sampled Price Comparison: Vape Oil .......................................................................15 3.2.2 Sampled Price Comparison: Oral Suspension Products ............................................16 3.2.3 Sampled Price Comparison: Capsules Products .......................................................17 3.2.4 Sampled Price Comparison: Topical Products ..........................................................19 3.3 Sales Data by Category ...................................................................................................21 3.3.1 Number of Units Sold and Sales by Product Type and Category...............................22 3.3.2 Number of Units Sold and Sales by Product Type .....................................................24 3.4 Average 30-Day Supply Cost by QCs ..............................................................................27 3.4.1 Average 30-Day Spend by the Number of QCs .........................................................27 3.4.2 Average 30-Day Spend by Specific QC.....................................................................29 Appendix A ...............................................................................................................................32 A.1 Historical Cannabis Prices – LeafLine and MinnMed .......................................................32 A.1.1 Current and Historical Medicine Price List – LeafLine ...............................................32 A.1.2 Historical Medicine Price List – MinnMed ..................................................................34 Report on Medical Cannabis Price Study i Table i: Version History Version Completed Date Update Reason Final 1.0 May 8, 2020 Final 1.1 February 17, 2021 Corrected a typo. Final 1.2 August 11, 2021 Corrected errors in table 3.4.1-2 and table 3.4.2-1 Report on Medical Cannabis Price Study ii 1.0 Introduction 1.1 Project Background The State of Minnesota (State) is one of 33 states that allow qualifying patients to purchases cannabis for healthcare treatment. Legislation passed in 2014 legalized the sale of cannabis to Minnesotans who are diagnosed with certain medical conditions. Patients must enroll in the medical cannabis patient registry maintained by the State to be eligible to legally purchase and possess medical cannabis. The annual enrollment fee is $200; however, a reduced annual fee of $50 is available for Minnesotans receiving medical assistance, such as: MinnesotaCare Social Security Disability (SSD) Supplemental Security Income (SSI) Medicaid/Medical Assistance (MA) As part of the application process, the patient’s qualifying condition (QC) must be certified by a healthcare practitioner as having at least 1 of the 14 QCs listed below. The patient must be reevaluated and have their qualifying medical condition(s) recertified annually by a healthcare practitioner. 1 Cancer associated with severe/chronic pain, nausea, severe vomiting, cachexia, or severe wasting 2 Glaucoma 3 Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) 4 Tourette’s syndrome 5 Amyotrophic lateral sclerosis (ALS) 6 Seizures, including those characteristic of epilepsy 7 Severe and persistent muscle spasms, including those characteristic of multiple sclerosis 8 Inflammatory bowel disease, including Crohn’s disease 9 Terminal illness, with a life expectancy of less than one year, if the illness or treatment produces severe/chronic pain, nausea, severe vomiting, cachexia, or severe wasting 10 Intractable pain (effective August 1, 2016) 11 Post-traumatic stress disorder (effective August 1, 2017) 12 Autism (effective August 1, 2018) Report on Medical Cannabis Price Study 1 13 Obstructive sleep apnea (effective August 1, 2018) 14 Alzheimer's disease (effective August 1, 2019) According to the January 2020 Medical Cannabis Program Update issued by Minnesota Department of Health (MDH), 18,249 patients were actively enrolled in the patient registry as of December 31, 2019. This was a 27% increase (3,851) over the 14,398 enrollees as of December 27, 2018. 1.2 Office of Medical Cannabis (OMC) OMC was formed in 2014 as a unit within MDH. OMC oversees the State’s medical cannabis program to help ensure that patients and medical cannabis manufacturers comply with eligibility requirements, payment requirements, and other legal requirements. The key roles and responsibilities of OMC include1: Explaining program requirements and therapeutic uses of medical cannabis Enrolling and overseeing healthcare practitioners providing treatment to participating patients Verifying and enrolling qualifying patients, designated caregivers, parents, legal guardians, and spouses Collecting annual registration fees from patients and registered medical cannabis manufacturers Examining business and financial affairs, practices, and conditions of registered medical cannabis manufacturers 1.3 Registered Medical Cannabis Manufacturers Two manufacturers, LeafLine Labs (LeafLine) and Minnesota Medical Solutions (MinnMed), were registered on December 1, 2014. The manufacturers are responsible for the cultivation, production, and distribution of medical cannabis in the State. OMC assigned geographical service areas to each manufacturer, and each manufacturer is limited to two distribution facilities, also known as Cannabis Patient Centers (CPCs), per assigned geographical area. Each manufacturer established four CPCs within the State, for a total of eight CPCs. Registered patients can purchase medical cannabis from any one of these eight CPCs. As of March 2020, MinnMed operates CPCs in Bloomington, Minneapolis, Moorhead, and Rochester; and LeafLine operates CPCs in Eagan, Hibbing, St. Cloud, and St. Paul. 1Office of the Legislative Auditor, Minnesota Department of Health Office of Medical Cannabis – Internal Controls and Compliance Audit of July 2016 through December 2018 (January 2020) Report on Medical Cannabis Price Study 2 1.4 Products Offered in Minnesota and Definitions Two primary therapeutic cannabinoids— delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) —are found in varying ratios in the cannabis plant. THC is the more widely known of the two because of its psychoactive effects, which create a “high” in users. CBD is non- psychoactive (i.e., it does not create a “high”), and might be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly treating mental illness and addictions. The 2014 legislation that legalized medical marijuana production and sale also limited products to pills or liquids (including oil). All products offered in Minnesota are considered concentrates, which means the marijuana has undergone processing to isolate the desirable properties of cannabis. Minnesota does not allow the sale of flower cannabis, edibles, or other forms of non- liquid concentrates that can be sold in other states. LeafLine and MinnMed offer a variety of products, including cartridges, syringes, bulk oils, oral suspension solutions, and tinctures. We grouped these products into the following four categories: 1. Vape Oil: General term for cannabis concentrate in an oil form that is vaporized. Cartridge: Vape oil that has been prefilled into a glass cartridge for vaporization with a battery. Syringe: A syringe of cannabis concentrate; similar to a cartridge, except it must be transferred from the syringe to another vaporizing device to be consumed. Bulk Oil: Similar to a syringe, bulk oil is cannabis concentrate that is often used as a “refill” for