News
Germany’s Cannabis Reimbursement Divide: Why a Prescription Does Not Guarantee Payment
Changes to Germany’s health insurance rules have left patients facing new limits on funded cannabis treatment. Cannabis Health explains the rules and the industry’s objections.
Why do insurers pay for some cannabis medicines but not others – and what does that mean for patients prescribed them?
Cannabis Health explores these questions just weeks ahead of its Frankfurt Symposium, taking place on 4 November, which is set to explore Germany’s changing prescribing rules.
It comes after a law passed by Germany’s parliament this summer removed cannabis flower from public health insurance cover.
Most spending comes from patients paying privately
Patients paying for their own prescriptions account for approximately three-quarters of Germany’s medical cannabis market, according to the European Cannabis Insights 2026, published by Business of Cannabis and Prohibition Partners, which estimates the market is worth approximately €1.15 billion in 2026.
Public insurance generates less than a quarter of its value, despite covering around 90% of Germany’s population, as Business of Cannabis reported in August.
| Who Pays? | Estimated Share of German Medical Cannabis Market Value |
|---|---|
| Patients paying privately | Around 75% |
| Public health insurers | Less than 25%. |
The report found that physician liability concerns, persistent insurer refusals, and the structural complexity of GKV prescribing have kept reimbursed volumes limited, a situation that became more acute when Germany legislated to remove cannabis flowers from GKV-covered products in July this summer.
Germany’s market expanded following the April 2024 cannabis reforms, which removed medical cannabis from narcotics legislation.
As Cannabis Health previously reported, online clinics allowed patients to consult a doctor remotely and, if prescribed cannabis, have it delivered by a pharmacy, without visiting a clinic in person.
Why did Germany stop funding cannabis flower?
The decision followed recommendations from a commission appointed to examine Germany’s public health insurance finances.
Its report, published in March, said there was “limited evidence” for cannabis flower and difficulties ensuring consistent doses.
It argued that certain licensed medicines had a “significantly more robust evidence base” and recommended retaining funding for extracts and manufactured cannabis medicines.
The commission estimated annual insurance spending on cannabis at approximately €200 million, around half of it on flower.
Removing flower from cover was forecast to save approximately €130 million in 2027. That calculation assumed only 10% of patients previously receiving funded flower would switch to other funded treatments, while some would continue buying flower and “pay themselves”.
The restriction took effect on 30 July.
Germany’s pharmacists’ association, ABDA, explained that pharmacies could “continue to dispense cannabis flower” on a private prescription, leaving patients to cover the cost.
The industry disputes the savings
The German Cannabis Business Association, BvCW, disputed the expected savings and argued that the changes restrict doctors’ treatment choices.
In a statement issued this summer, managing director Michael Greif warned: “Rather than reducing costs for statutory health insurers, it is likely to increase them.”
He argued that medicines prepared for individual patients often cost less than manufactured products, while doctors’ freedom to choose treatment was being “severely restricted”.
Kathrin Konyen, coordinator of the association’s medical cannabis division, said the approach “jeopardises successful therapies” and urged lawmakers to prioritise “individual medical needs”.
The association called for protection for patients already receiving treatment and for the six-month requirement to try a licensed medicine first to be removed or shortened.
Which medicines will insurers still pay for?
Section 31(6) of German law still provides for insurance-funded cannabis extracts and medicines containing dronabinol or nabilone, subject to conditions.
Extracts contain substances taken from the cannabis plant and can be supplied as oils. Dronabinol is THC, the compound responsible for cannabis’s intoxicating effects; nabilone is a synthetic substance with a similar action.
Under the law, patients must have a “serious illness”. A recognised standard treatment must be unavailable or unsuitable for that patient, taking account of their condition and possible side effects.
The law also requires a prospect of a “noticeable positive effect” on the illness or its “serious symptoms”.
Must patients try a licensed medicine first?
The law requires treatment to begin with an approved cannabis medicine as part of a “six-month treatment trial”.
However, the National Association of Statutory Health Insurance Physicians, known as KBV, says doctors can end the trial “before the end” of six months if the medicine does not work or the patient cannot tolerate it. They can then prescribe an extract or another individually prepared cannabis medicine.
KBV also says patients treated with cannabis extracts or individually prepared cannabis medicines before 30 July 2026 “continue to be entitled to them” and do not have to undertake the trial.
Does the insurer have to agree first?
Whether patients need their insurer’s permission also depends on who treats them.
Since October 2024, certain doctors, including GPs and neurologists, have been able to prescribe qualifying cannabis medicines at the public insurer’s expense without asking it to approve payment first.
Germany’s Federal Joint Committee, known as the G-BA, introduced the change. Other doctors generally still need the insurer’s agreement before treatment begins.
Patients must meet the same medical requirements in either case.
According to KBV’s guidance, a funding request must explain how serious the patient’s illness is, why standard treatments cannot be used and what benefit cannabis is expected to offer.
These are the requirements for funding, rather than a guarantee of approval. They apply to medicines that remain covered; they do not reverse the general exclusion of flower.
What will the Frankfurt session examine?
The Frankfurt session will examine which patients are most affected by the loss of insurance-funded cannabis flower, what alternative treatments are available and how doctors can support those facing new costs.
It will also consider how proposed restrictions on online appointments and mail-order prescriptions could affect patients’ treatment.
The symposium takes place at Mainhaus, Frankfurt, on 4 November, with sessions covering prescribing, chronic pain, mental health, pharmacy and patients’ rights.
Get the weekly briefing
A round-up of the latest science, regulation and developments across the UK and Europe — in your inbox every week.