Is Germany Planning To Restrict Medical Cannabis Insurance Reimbursements?

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Germany is home to Europe’s largest medical cannabis market, which is not surprising given the size of Germany’s population and economy. Since 2017, doctors in Germany have been permitted to prescribe medical cannabis products to suffering patients, and the cost of those products is often reimbursed by insurance companies. Having medical cannabis covered by insurance is a concept that medical cannabis advocates push for all over the globe, with Germany being somewhat of a rare success story. Unfortunately, things may be changing in Germany on this front, at least for some patients.

The Gemeinsamer Bundesausschuss (G-BA), which belongs to the Bundesministerium der Gesundheit (Ministry of Health), is tasked with reevaluating the GKV (statutory health insurance) reimbursement for cannabis medications following the finalization of the 5-year observational analysis after the medical cannabis law was initially adopted in 2017. Conclusions will rely heavily on the results of the BfArM 5-year observation.

How Will Changes Affect Germany’s Medical Cannabis Program?

One of the more restrictive changes being proposed in Germany includes general practitioners no longer being permitted to prescribe cannabis to patients whose costs are expected to be reimbursed by GKV. Such prescriptions would be reserved for specialists with additional qualifications. The policies regarding use of cannabis as a last resort could also be overhauled.

Currently, German doctors can prescribe cannabis flower instead of cannabis extracts if they feel that it’s a more suitable form of treatment. However, ‘special justification’ would be required for a cannabis flower prescription if proposed changes are adopted. Many of the proposed changes would directly increase the burden of documentation for doctors, particularly during first 3 months of treatment. For instance, doctors would also need to explain in writing why THC-dominant strains are being prescribed versus CBD-dominant strain.

All of this increases pressure on doctors to prescribe extracts instead of flowers, regardless of what is best for the patient, in addition to driving up costs for insurance companies. The process of considering proposed changes is already underway and ends at the end of this month, with a final decision on the matter possibly being rendered by early next year.

Legalization Is A Factor

What is going on right now in Germany regarding medical cannabis policy is not occurring in a vacuum. Obviously, the medical cannabis policy discussion is running parallel to the ongoing adult-use legalization discussion that is also occurring in Germany. For insight regarding how one may affect the other, I reached out to Dr. med. Julian Wichmann, Geschäftsführer/CEO of Algea Care.

“Lacking scientific evidence on the efficacy of medical cannabis remains a big issue in Germany. This is now starting to negatively impact healthcare politics and therefore reimbursement. Academic institutions and companies need to work closer together to fill this gap.” Dr. med. Julian Wichmann stated.

Algea Care has established multiple research collaborations with German university hospitals, with the first positive results recently being presented on outcomes in treating neuropathic pain with cannabis flowers.

“Increasing healthcare cost pressure and already implemented insurance premium increases have insurers looking for opportunities to reduce expenses. In pharmacies, manual work associated with cannabis prescriptions remains high due to extensive documentation duties. The plans for removing medical cannabis from the narcotics law (BtmG) could therefore lead to substantial cost savings and make medical cannabis more affordable for insurances and patients.” Dr. med. Julian Wichmann concluded.

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