A guide to cost coverage for medical cannabis in Germany
24.05.2023 • News
The medical use of cannabis has gained increasing importance in Germany in recent years. For patients suffering from certain conditions such as chronic pain, multiple sclerosis, or cancer, medical cannabis can be an effective alternative. However, many patients wonder how they can obtain cost coverage for their cannabis medication. In the following text, a comprehensive guide will be presented to help you understand and navigate the process of cost coverage in Germany.
Requirements for medical cannabis therapy
To be treated with cannabis-based medications in Germany, several basic requirements must be met:
- The condition must be a serious illness.
- The patient must have exhausted all available therapy options.
- There must be a prospect of treatment success.
- The principle of cost-effectiveness must be ensured.
If these criteria are met by the patient, there are several ways to apply for cost coverage.
Step 1: Consultation with the doctor
The first step towards cost coverage for medical cannabis is to consult a qualified doctor. In Germany, any specialist or general practitioner is allowed to prescribe medical cannabis. The intuitive doctor search provided by Weed! can be helpful in finding a doctor who already deals with medical cannabis therapies. Alternatively, you can consult your own treating specialist, such as an oncologist or pain specialist. The doctor will review the medical history, if not already known, and decide whether cannabis treatment is appropriate for the specific condition.
It should also be noted that cannabis is not suitable for all patients. There are contraindications that need to be considered because cannabis is not suitable for everyone. The most common reasons for prescribing medical cannabis are chronic pain, cancer, spasms, multiple sclerosis, anorexia, depression, nausea, and migraines.
Applying for cost coverage from health insurance
Before receiving a medical prescription for cannabis, an application for cost coverage must be submitted to the health insurance company. The application should contain detailed information about the medical situation, including the diagnosis, previous treatment methods, and the medical benefits expected from the use of cannabis. The doctor can request the application from the health insurance company or online through copeia.
The application must be accurately filled out, and relevant documents should be provided by the doctor. Ideally, an extract of previous treatments should also be included, which can be requested from the health insurance company. It is also helpful to include a personal letter containing significant studies to substantiate the prospects of success. This is a very comprehensive procedure, and it is possible to seek assistance from professionals who can conduct research and formulate such letters. You can find them as experts in cannabis medicine or consultants for cannabis medication on the Internet.
It is important to note that health insurance companies in Germany individually review and decide on cost coverage applications for medical cannabis. There is no guarantee of approval, but since the GBA amendment, insurers can only reject in verifiable exceptional cases, which was different before the amendment. Therefore, in recent years, the chances of cost coverage have improved as legal decisions tend to favor patients with certain conditions. Nevertheless, numerous applications are still rejected.
Please keep in mind: The insurance company has 3 weeks to respond to the application, for palliative care, it is only 3 days. If the insurance company does not respond, the application is considered approved.
Step 3: Appeal options and legal assistance
If the application for cost coverage is approved, congratulations! According to a press release from the G-BA, only the initial prescription for cannabis needs to be approved by the insurer. Follow-up prescriptions, dosage adjustments, or switching to other flowers or extracts do not require re-approval.
If the application for cost coverage is rejected, there are two options: either submitting a new application or filing an appeal. This is a longer process that should be carefully considered. Information about the specific reasons for the rejection, as well as additional medical evidence or expert opinions, can be very helpful in both cases. A specialist can assist you in this process as they know how to argue effectively and have the necessary experience in dealing with insurance companies. In some cases, it may be advisable to seek legal assistance to fight for cost coverage in court. There are law firms specializing in medical cannabis that can help with legal questions and steps. If it reaches the point of filing a lawsuit with the social court, it is essential to have a lawyer and involve the Social Association VdK.
Inpatient pain therapy and cost coverage
There are now numerous clinics in Germany that also deal with cannabis medicine. In the case of inpatient pain therapy, external approval is no longer required as it is obtained during the hospital stay. The usually 14-day hospitalization includes various therapies and allows for precise adjustment of the patient under observation. The clinics take care of the application process, and the patient is then discharged as a cannabis patient.
The bottom line
Cost coverage for medical cannabis in Germany will continue to be a complex process that requires patience, perseverance, and often external assistance. It is important to work with a qualified doctor and submit a well-founded application to the health insurance company, for which you can seek the help of professionals. In the case of rejection, you have the right to appeal and, if necessary, seek legal support or submit a new application. Inpatient pain therapy is also an option. Despite the challenges, the chances of cost coverage have improved in recent years, and more and more patients have access to the benefits of medical cannabis therapy. It is desirable that this number continues to grow.
Author: Melanie Hermann for Weed!