The FDA has so far onlyapprovedCBD-based drug Epidiolex to treat rare forms of epilepsy. This narrow approval reflects both regulators’ caution and the fact that high-quality clinical trials are still limited for most of the other conditions where cannabis is being promoted.

Critics warn that a Medicare pilot program could endanger seniors, a demographic that often takes multiple daily medications. Arecent FDA-funded studysuggested that prolonged CBD use may cause liver toxicity and interfere with other life-saving medications.

“It’s not at all based on science. This is all based on money, and it’s egregious.

That’s not the way we make medical decisions,” said Meg Haney,directorof the Cannabis Research Laboratory at Columbia University. “(Kessler), who’s a buddy with the president … can make a lot of money selling something that has no evidence behind it.”

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Otherresearchhas cast doubt on cannabis’ efficacy entirely, suggesting itmay not be effectivefor many of the conditions targeted by the proposed pilot, Haney said.

For example, a2023 reviewof 134 studies involving adults age 50 and older found medical cannabis to have inconsistent outcomes for improving conditions like end-stage cancer and dementia. The review also found frequent links to harms including depression, anxiety, cognitive impairment and injury.

Rescheduling cannabis would, however, ease barriers to conducting clinical trials that experts say have historically stifled scientific research.

“Medical research has effectively been under lock and key,” said Ryan Vandrey, a Johns Hopkins University professor who helps run its Cannabis Science Lab. “Schedule I makes large, placebo-controlled trials incredibly difficult. Without that data, policymakers are being asked to make decisions in the dark.”

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For investors, the specific terms of rescheduling are critical.

Rescheduling would improve growers’ access to banking and financial services because it would liftcertain IRS taxrestrictionswhich bar cannabis businesses from deducting standard expenses.

The economic backdrop is already shifting: The annual value of the U.S. cannabis production jumped 40% last year from the previous year,accordingto the Department of Agriculture. The global market for cannabis-derived products is projected to hit $160 billion global market by 2032, according toGrand View Research.

Rumors of rescheduling and a possible pilot program helped shares of weed producersTilray BrandsandCanopy Growthjump 44% and 52%, respectively, on Friday.

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As Seymour described it, Medicare coverage and federal insurance involvement is the “holy grail” that could unlock institutional capital.

A Schedule III classification could also help legitimize the sector for institutional investors who have been hesitant to wade in, paving the way for stocks to be listed on the New York Stock Exchange and Nasdaq and shifting valuations from retail sentiment to fundamental cash flows.

“The Schedule I classification is what has held back a lot of institutional investors,” Seymour said. “Having to go out and tell their shareholders … that they own a company who’s selling something that is on a par with heroin, LSD or cocaine … is kind of a tough thing to swallow.”

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Stocks of largest market cap cannabis companies in the U.S.

If cannabis shifts to a reimbursable prescription drug model or federal legality, the category could attract interest from major pharmaceutical companies and distribution could eventually migrate from state-licensed dispensaries to national pharmacy chains likeCVSandWalgreens.

That could spell trouble for smaller weed businesses.

Already, large pharmaceutical companies have the deep pockets needed to fund the multi-year, double-blind clinical trials required forFDA-approved drugs— abarrier to entrythat few current cannabis operators can surmount.

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However, Seymour views Medicare coverage as a catalyst for merger and acquisition activity rather than an immediate death knell.

“You are going to see consolidation in the sector,” Seymour said. “Smaller companies that have good businesses, that are profitable … are probably going to be seen as targets.”

Meanwhile,Green Thumb IndustriesCEO Ben Kovler foresees competition among pharmaceutical companies and cannabis companies to achieve medical breakthroughs.

“The pharma sector, in the past, has been a major lobbyist against (cannabis) because it is a threat,” Seymour added. “Therefore, yes, it’s a huge opportunity for pharma.”

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— CNBC’s Brandon Gomez contributed to this report.