Germany: reimbursement of medical cannabis not automatic

Germany has legalized medical cannabis on January 19 Following a vote by the Bundestag, general practitioners can now prescribe medical cannabis to their patients.

Before March, only 1,000 patients were authorized to purchase medical cannabis at pharmacies. Its initial price was set at about 15 euros per gram.

Following the new laws on medical cannabis, existing prescriptions are no longer valid. Patients (both new and existing) must now obtain a valid prescription from a qualified physician. There are now two types of prescriptions: private prescriptions, under which the patient is responsible for purchasing the medication, and insurance prescriptions, which guarantee reimbursement for the product. If the patient’s health insurance provider denies the claim, the Medical Review Board (MDK) is consulted to make a final decision.

A doctor who issues an «insurance prescription» without verifying reimbursement coverage risks incurring significant financial liability for the prescribed medication as well as for all other treatment costs. Given this potential financial burden, doctors frequently issue private prescriptions for cannabis.

Rise in Medical Cannabis Prices

Since the law went into effect, the price of cannabis has risen from 15 to 25€ per gram. Pharmacies attribute this price increase to the added costs associated with the German program. Medical cannabis must be packaged, labeled, and measured—and even ground if the doctor requests it—in accordance with the country’s pharmaceutical protocol before being dispensed to patients.

The result: on the one hand, we have a prohibitive price, and on the other, patients who have received private prescriptions that are not covered by insurance.

Medicinal cannabis supplies, however, remain limited for the time being. Germany had initially planned to import all of the cannabis available in pharmacies, until grow your own cannabis. In the meantime, instead of ensuring a steady supply under the new federal law, many patients remain without medical cannabis and have little chance of receiving reimbursement. Demand for medical cannabis, meanwhile, has far exceeded lawmakers’ projections.

What about growing your own food?

German law provides for the the option to grow your own medical cannabis. Many patients have submitted requests to the Federal Institute for Drugs and Medical Devices (BfArM) to grow it themselves. However, more than 130 applicants were threatened with additional fees if they did not withdraw their applications after the new law took effect. This is absurd, given that growing one’s own cannabis costs about 150€ per month, compared to more than 2,000 euros for treatment at a German pharmacy. In neighboring Netherlands or in Canada, the same type of treatment would cost no more than 600€.

Patients who can afford it have filed new complaints against their health insurance companies, which still seem reluctant to cover medical cannabis despite the law coming into effect, and have had their treatment reimbursed once again.

Mehdi Bautier