Cannabis on prescription - for whom is it possible?

Obtaining cannabis on prescription has been possible in Germany since 2017. But it's still not easy. The fact that a doctor considers treatment with cannabis to be sensible is not sufficient as justification. Before the start of therapy, insured persons must submit an application for approval to the health insurance company. This must be supported by the doctor and justified in detail. After the application has been approved, the doctor can prescribe a cannabis medicinal product on the basis of a health insurance prescription.

How can I get cannabis on prescription?

Basically: Only patients with a serious illness are entitled to prescription cannabis medicines under certain conditions. This usually involves exhausting all treatment options that are considered standard for treating a particular condition (standard therapies).

Only if standard therapies are not (or no longer) sufficiently effective or have not been tolerated can cannabis therapy be considered at the expense of the health insurance company. If a standard therapy is available, but the doctor can justify that it cannot be used - for example because of contraindications - the costs can also be covered.

Yet another requirement must be met: there must be a not entirely distant prospect of a noticeable positive effect on the course of the disease or of serious symptoms. Although this does not require large-scale studies, a certain minimum level of high-quality scientific data must be available.

Those affected must then submit an application to the health insurance company. In this application, the previous course of treatment is described in detail. The health insurance companies often let the cases through medical service appraise. If the report shows that the requirements for cost coverage are not met, the application will be rejected by the health insurance company.

What diseases can I get cannabis on prescription for?

So it must be a serious illness. But which ones? Diseases fall into this category? That's not an easy question to answer. While there are lists of possible illnesses, these only provide a guide. They are not stipulated by law. This has advantages and disadvantages for patients. Since no serious illness is explicitly excluded, potentially every seriously ill person has the opportunity to receive cannabis therapy. On the other hand, the assessment of which patient is considered to have been treated is not always clear.

The so-called accompanying survey took place from March 2017 to March 2022. Physicians whose patients applied for cannabis therapy had to fill out a questionnaire several times during the course of therapy. The aim of this study was to obtain more detailed information about which diseases cannabis is most commonly used for, what the success rates of treatment are, which cannabis medicines are used and which specialist groups predominate in prescribing cannabis medicines.

The results of the survey were summarized in a report . The most common symptoms and diseases treated with cannabis therapy were:

• Pains
• Neoplasms (Tumors)
• spasticity
• Anorexia (anorexia)/ wasting (unwanted weight loss, usually associated with a AIDS disease)
• multiple sclerosis
• Nausea and vomiting as part of a chemotherapy

In more than three quarters of all cases, cannabis medicines were prescribed for the treatment of chronic pain. Across all areas of application, the cannabis drug dronabinol ( THC ) was used most frequently, followed by cannabis flowers, nabiximols (Sativex® spray for use in the oral cavity; contains cannabis extract with THC and CBD ) and cannabis extracts in liquid form for oral use.

THC (Tetrahydrocannabinol) is the main active ingredient in the cannabis plant and is psychoactive in high concentrations. CBD (cannabidiol) is the second important active ingredient in cannabis. CBD is not psychoactive and can reduce the negative effects of THC dampen It also has an anti-inflammatory effect.

Also the Association of Cannabis Dispensaries (VCA) collected data up to April 2022. In contrast to the accompanying survey, patients were interviewed here. It is possible that these results will provide further insight into the prescribed cannabis medications.

The permit is there - what's next?

If your application for treatment with cannabis has been approved by the health insurance company, you will receive a notification from your insurer. Then it can go. You will receive a health insurance prescription for a specific cannabis preparation from the doctor treating you.

Unlike many other drugs, the dosage must be found individually for all those affected. To states of intoxication by contained THC to avoid it is usually started with a very low dose. If this is well tolerated, it is slowly increased until the desired effect is sufficiently strong.

If you do not feel comfortable with a prescribed preparation, the side effects are unpleasant or the symptoms are not (sufficiently) alleviated, talk to your doctor. Sometimes it takes time for the body to get used to the treatment and side effects to wear off. In some cases, a different dosage or a different preparation can be useful. Incidentally, as a patient, you cannot choose which cannabis medicine you would like to have. Your doctor will decide on this.

Cannabis on prescription - the cost

If you have received your approval from the health insurance company, you may be wondering whether you will still have to pay for medical cannabis. In principle, your insurer will bear the costs if your application is approved. As with all medicines, however, you must pay the statutory co-payment ("prescription fee"). This is ten percent of the price of the drug, but no less than 5.00 and no more than 10.00 euros. You can find out more about your personal contribution here. You can also read there the conditions under which you can be exempted from the co-payment.

What to do if the application for cannabis on prescription is denied?

Has your application for reimbursement been rejected? As already described, the criteria are strict. Refusal means that you do not meet the required requirements.

If the health insurance company refuses to cover the costs, you have the option of appealing within one month of receiving the letter of rejection. The objection should be justified. This means that you should state in writing why you do not agree with the decision. We advise you to enclose a medical statement with your objection.

The processing time of appeals depends on many factors. If research is still necessary, it may take longer. If there are no new findings, the decision of the health insurance company remains and your objection will be forwarded to the objection committee immediately. He will make a final decision within a few weeks. If the committee was unable to remedy an objection, insured persons then have the opportunity to file a complaint with the responsible social court. This is also free. In principle, the social court in whose district the plaintiffs have their domicile or place of residence at the time the complaint is filed is locally responsible.

Another option is to obtain the medication at your own expense with a private prescription. The prerequisite for this is that a doctor agrees to prescribe the medication. However, not every patient can afford to pay for the expensive medication themselves. For some, the idea of ​​treating themselves with cannabis illegally acquired from the black market is obvious. However, self-medication without medical supervision and with illegally acquired cannabis is strongly discouraged. There is a clear difference in quality and potency between medical and illegal cannabis. You can find out more about this here .

Which doctor prescribes cannabis?

With the exception of dentists and veterinarians, every family doctor and specialist practice can prescribe cannabis medicines.

If you believe that cannabis therapy could be an option for your serious illness, please discuss this with your doctor.