Notes from SALGBA: Where Cannabis Fits in the Public-Sector Benefits Conversation

By Rachel Strauss, Founder & CEO of PBM Princess | Advisor to Leafwell

May went by in a blur (and if you are parents of school-aged children, you know what I mean) — but one thing that happened early on: I took another state off my bucket list!

I headed to Rhode Island to attend SALGBA, the annual gathering of state and local government benefits leaders — this time representing Leafwell, the clinician-guided medical cannabis platform I serve as an Advisor to. It was my first time at this particular conference, and I walked away with a clearer view of where cannabis therapy fits in the public-sector benefits landscape … and where it doesn’t.

Public-sector plans are wrestling with the same cost curve as everyone else, with one key difference: budget transparency and political accountability mean every dollar gets scrutinized. The conversations we had — with state employee plans, public-sector risk pools, brokers serving government clients, and cooperative purchasing groups — kept circling the same problem.

Chronic conditions, particularly the cardiometabolic cluster, are eating more of the plan year over year. The standard playbook of point solutions, condition management vendors, and pharmacy spend controls is producing diminishing returns. What struck me is how often the upstream drivers of cardiometabolic decline get treated as background noise. Chronic pain pushes people toward opioids and gabapentinoids, sedentary behavior, and weight gain. Insomnia independently dysregulates glucose and blood pressure.

Untreated anxiety and depression worsen every metric the diabetes program is trying to move. Plans pay for the consequences downstream — through ER visits and polypharmacy — while the data we collect often goes unaddressed without strategy.

This is where cannabis therapy belongs in the conversation: not as a competing chronic condition program, not as a wellness perk, but as an upstream clinical intervention. When clinicians guide patients through medical cannabis as part of an integrated care plan, the outcomes are meaningful. In Leafwell’s program, participating patients have reported an average of roughly 35% fewer ER visits, a 57% reduction in prescription use, and 46% improved sleep quality.

This translates to around $5,000 in annual savings per participating employee, concentrated in exactly the categories self-funded public plans struggle to bend. But I want to be honest about the nuance — especially because it’s not a secret.

Cannabis isn’t a fit everywhere. State regulatory frameworks vary widely, from broad medical and adult-use access to narrow programs covering specific conditions.

Leafwell believes clinical guidance is non-negotiable.

This is a clinical pathway, not a retail benefit. And success depends on integrating with the chronic condition programs already in place, not standing apart from them. The most productive conversations at SALGBA started from that honest place. Where does this fit in your existing chronic condition strategy? Where doesn’t it? What does the regulatory framework allow in your state? Which population would benefit most?

Those are the right questions, and the public-sector benefits world is getting more comfortable asking them. If you were at SALGBA and we didn’t get to connect, I’d welcome the conversation. Public-sector plans have a particular responsibility — and a particular opportunity — to think clearly about what actually moves health outcomes for the people they cover.

Cannabis therapy, used the right way, deserves a seat at that table.

Have questions about where cannabis therapy fits in your benefits strategy? That’s exactly the kind of conversation I have every day at PBM Princess. Let’s talk.