Comment from Pixie’s Pantry

Request for Guidance Under IRC §213(d): Medical Cannabis Administration Technology I respectfully request that the Department of the Treasury and the Internal Revenue Service add the following item to the 2026-2027 Priority Guidance Plan: “Guidance under Internal Revenue Code §213(d) regarding whether certain non-combustion medical cannabis administration devices may qualify as medical equipment or supplies when used by qualified patients for diagnosed medical conditions, supported by practitioner documentation, and limited to legally regulated medical-use contexts.” This request is not asking the IRS to approve a retailer, brand, product catalog, cannabis flower, cannabis concentrates, or recreational-use accessories. It is a request for category-level guidance regarding a narrow class of medical administration devices. Requested category name: Medical Cannabis Administration Technology Suggested definition: “Non-combustion equipment or supplies used primarily by a qualified patient to administer legally regulated medical cannabis for the diagnosis, cure, mitigation, treatment, or prevention of disease, when the patient has a diagnosed medical condition and the use is supported by practitioner documentation.” Guidance is needed because patients, plan administrators, merchants, third-party administrators, SIGIS, and benefits-card processors currently lack a clear standard for determining whether these devices may be treated as medical equipment or supplies under §213(d). This creates uncertainty for taxpayers and administrators. Patients in state medical cannabis programs may have practitioner documentation supporting medical cannabis use for chronic pain, cancer-related symptoms, neurological conditions, seizure disorders, PTSD, and other qualifying conditions. However, the equipment used to administer that therapy is often treated as a general-use or recreational accessory, even when the patient’s use is medical, documented, and tied to a diagnosed condition. Many patients are advised to avoid smoking or combustion. For those patients, a non-combustion administration device may be the practical equipment needed to administer treatment in a manner consistent with their health needs. Without guidance, patients may be unable to use tax-advantaged medical funds for safer or more appropriate administration equipment and may default to lower-cost combustion methods. I respectfully request guidance clarifying whether medical cannabis administration technology can qualify as medical equipment or supplies under §213(d) when all of the following conditions are met: 1. The patient has a diagnosed medical condition; 2. The patient is a qualified medical cannabis patient under a state-regulated medical cannabis program, or is using a legally regulated medical cannabis product; 3. A licensed medical practitioner recommends or documents the patient’s medical need; 4. The device is used primarily for medical administration, mitigation, treatment, or symptom management; 5. The expense would not have been incurred but for the patient’s medical condition and treatment plan; 6. The product is non-combustion administration equipment, such as a medical-use vaporization device or related administration accessory; 7. The guidance excludes cannabis flower, concentrates, or controlled substances themselves unless separately authorized by federal law; 8. The guidance excludes general-use smoking accessories, recreational-use products, novelty items, and products marketed primarily for adult-use consumption. A narrow safe harbor or clarification would reduce controversy, lessen taxpayer and IRS burden, promote sound tax administration, and allow uniform application by plan administrators and benefits-card systems. It would also help prevent unsupported eligibility claims by creating a clear documentation-based standard. Suggested publication language: “You may include in medical expenses the cost of certain medical cannabis administration devices if the device is used primarily to administer legally regulated medical cannabis for a diagnosed medical condition, the need is substantiated by a licensed medical practitioner, and the device would not have been purchased but for the medical condition. This does not include cannabis flower, concentrates, controlled substances not legal under federal law, general-use smoking accessories, recreational-use products, novelty items, or items used primarily for personal, living, family, or general wellness purposes.” This requested guidance would address an insufficient and unclear area of existing guidance, reduce burdens on small businesses and patients, and avoid inconsistent treatment by merchants, SIGIS, plan administrators, third-party administrators, and taxpayers. Thank you for considering this request.