ALBANY — As recreational marijuana shapes up to be a tough sell for New York lawmakers this session, there is one marijuana deal on the table that appears poised to move with little fanfare.

A bill introduced this month by Assemblyman Richard Gottfried and Sen. Diane Savino, both downstate Democrats, would make it a lot easier for patients to get medical marijuana in the state, following years of concerns about access from patients, providers and industry insiders.

Building on proposals in Gov. Andrew Cuomo's executive budget, the bill would allow health care providers to decide who should have access to the drug, increase the number of dispensaries statewide, eliminate patient registration fees, and remove a ban on the sale of smokable marijuana bud.

"One of the things that's been abundantly clear from the very beginning is that this was a narrow program that only served a small number of patients," Savino said. "We saw some improvements over the years, but now we're trying to really close those remaining gaps."

New York legalized marijuana for medicinal use in 2014, but a program wasn't implemented until January 2016. Since then, the Department of Health has certified 100,283 patients for its medical marijuana program.

That's fairly low compared to similarly sized states with medical programs. Florida, for example, has enrolled nearly three times as many patients (294,700) in half the time (its program launched 18 months after New York's).

Industry leaders theorize the slow growth is due to the many limits on New York's program. Only 40 dispensaries are allowed statewide (35 are currently operational) and eligibility is limited to 13 medical conditions. Additionally, patients can only access 30 days' worth of the drug at a time — a major barrier for residents in far-flung areas of the state.

What the bill does

The bill currently under consideration appears to move in the direction of treating medical-grade cannabis like any other medication.

"We believe cannabis is medicine and should be treated as such," said Dr. Stephen Dahmer, chief medical officer at Vireo Health, which operates a dispensary in Albany. "This (bill) attempts to put it on a level playing field."

One obvious example is that it allows health care providers to decide whether their patients would benefit from medical marijuana, removing a requirement that patients have one of 13 state-approved medical conditions in order to qualify. Anyone who is authorized to prescribe a controlled substance, including podiatrists and dentists, could recommend patients for the program.

"It would basically be between you and your doctor, as it should," Savino said.

Dahmer drew a comparison to the medical practice of off-label prescribing, in which a doctor directs a patient to take a drug outside of its intended or approved use, on the belief that it's in their best interest.

The bill would also remove some financial barriers to the program by eliminating a $50 patient registration fee, and allowing the sale of smokable marijuana. This is the cheapest form of retail marijuana, but it's currently banned in New York.

"As a physician, I would prefer other forms over smoke, but I'm also very aware of the financial challenges our patients face when paying out of pocket," Dahmer said.

Insurance companies don't cover medical marijuana, due to its federal illegality. And because pharmaceutical-grade cannabis is so expensive, many patients end up unable to afford medical marijuana.

The bill would also ease travel burdens. Patients are currently limited to a 30-day supply of cannabis. The bill would increase that to 60 days. It would also double the number of allowed dispensaries per registered organization from four to eight, bringing the overall number of allowed dispensaries statewide to 80.

"We have patients who travel up to three hours to a dispensary, some who are wheelchair-bound and severely debilitated," Dahmer said. "We try to access them through delivery, but some are unfortunately outside those zones."

Another big change would enable health care facilities such as nursing homes and group homes for the developmentally disabled to become "designated caregiver facilities" — allowing caregivers to obtain and administer medical marijuana to patients who may be unable to do so themselves.

It would also establish a medical marijuana research program in the state, expand third-party testing of cannabis products beyond the state's Wadsworth Laboratory, and allow companies to contract out ancillary functions such as security or transportation.

"We feel very confident about this bill because the people who opposed medical marijuana in the Senate in 2014 now wholeheartedly support it or are no longer here," Savino said. "In just a few short years, the thinking on this really has changed."