German Court Rejects Medical Cannabis Flower Reimbursement Challenge

But after the German Bundestag voted this summer to remove dried cannabis flower from statutory reimbursement, she applied to her insurer on 21 July to continue receiving it after collecting her final one-month prescription of 120g.

As Cannabis Health reported in July, the restriction formed part of a wider package aimed at reducing health insurance spending.

The woman, who is not named in the judgment, took her case to the Frankfurt Social Court – which hears disputes involving the country’s social security system, including statutory health insurance – arguing that the change would bring her treatment to an immediate end.

According to the judgment, she told the court she had a “severe, therapy-resistant neurological condition” for which “no standard treatment exists”.

She said her condition was stable on cannabis flower but that commercially available cannabis medicines were unsuitable because she could not tolerate them.

The woman also said she could not afford to continue treatment privately. At 120g a month and €8.50 per gram, her existing treatment would cost around €1,020 a month.

However, the Frankfurt Social Court rejected her application.

The court said that since the new rules came into force on 30 July, a legal right to receive cannabis flower through statutory health insurance “no longer exists”.

Crucially for existing patients, it found that “no transitional provision was created” for people whose treatment had already been approved.

The judgement said lawmakers had justified retaining standardised cannabis medicines while excluding flower partly because of a “greater risk of addiction” associated with inhalation, particularly during long-term treatment, and variations in THC and other active ingredients.

The legislation also estimated that removing flower from reimbursement would save around €130 million in 2027, rising to €180 million by 2030.

Although the court accepted that the woman had a serious neurological condition, it found that it was not life-threatening and therefore did not qualify for an exception.

The judgement said her remaining options were to try treatment with another cannabis-based medicine or obtain cannabis flower herself.

Extracts and dronabinol have now also become harder for patients to access through statutory health insurance.

The amended law now states that before any extract claim is valid under GKV, the treating physician must first prescribe an approved cannabis-containing finished medicine for a six-month therapeutic trial.

Only if that trial is completed, or if the statutory conditions for bypass are met, can a patient access extract reimbursement. Patients must have a serious illness where standard treatment is unavailable or unsuitable, and there must be a meaningful prospect of benefit.

The four finished medicines against which the six-month trial must be run are currently:

• Sativex, approved for spasticity in multiple sclerosis
• Epidyolex, approved for certain severe forms of epilepsy
• Canemes, approved for chemotherapy-related nausea and vomiting
• Exilby, a full-spectrum extract developed by Vertanical and approved in June 2026 for chronic back pain, though still in price negotiations with the Federal Joint Committee and not yet listed on the reimbursed market.

The case comes as Germany continues to debate how medical cannabis should be prescribed, funded and regulated – issues that will be examined at the Cannabis Health Symposium Frankfurt on 4 November.

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The Cannabis Health Symposium Frankfurt will take place at Mainhaus on 4 November 2026.

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