Before the introduction of Germany’s new medical marijuana law this March, barely more than 1,000 domestic patients (including the author of this article) were legally permitted to buy medical cannabis from pharmacies, paying the standard rate of 15 Euro/gram. These patients’ medical histories and needs were examined and approved by various medical practitioners, including those of the Federal Institute for Drugs and Medical Devices (BfArM).
Shortly after Germany’s new medical marijuana law took effect in March, existing medical marijuana permissions became invalid — old as well as new patients needed to receive a new cannabis prescription from a qualified doctor. In cases where a doctor supplies a so-called “private prescription,” the patient must pay for their medicine out of pocket. An “insurance-prescription,” on the other hand, guarantees reimbursement. If a patient’s health insurance denies their reimbursement, the Medical Service of the Health Insurances (MDK) is consulted for a neutral final decision. The MDK was founded by all German health insurance companies to determine the action for special cases of medical issues and reimbursement. For example, the MDK decides how many hours of medical help a disabled person gets paid per day or whether an expensive therapy may be necessary.
A doctor who issues an “insurance-prescription” without the commitment for reimbursement risks financial liability for the prescribed medicine and all other therapy costs. With this potential financial burden at play, doctors frequently hand out private prescriptions for cannabis but rarely consider issuing a coveted “insurance-prescription” if the health insurance had not already approved the patient’s reimbursement application.
Since the introduction of Germany’s new law, cannabis prices have risen over 66% from 15 to 25 Euro per gram. The pharmacies justify this with the complicated fee schedule in the German healthcare system. Since March 2017, medical cannabis is legally considered a “recipe substance,” meaning the raw material had to be repacked, labeled, and dosed (ground) according to German pharmaceutical standards before being handed over to patients. If the physician notes “not crushed” on the prescription, the pharmacies will dispense whole flower as opposed to ground herbs, but the fee remains the same.
Six weeks after the new law became effective, it seemed clear health insurance funds and the MDK would refuse almost all claims for reimbursement. Even a large number of former state exemption holder’s applications were being rejected. Most patients have been unable to finance their medical expense at a price of 23-25 Euro/gram since the new law came into effect. In addition, thousands of new patients have received a “private prescription” for few grams of cannabis from their doctor in order carry legal buds for the first time ever. Due to the large influx of new patients, the supply of medical cannabis remains low despite its high price. At the end of June, only three or four of the 14 available strains were being sold in most pharmacies. Instead of guaranteeing a regular supply of medicine as the new law intended, many patients in Germany are left without medicine and little chance of receiving reimbursement. In the face of these many hurdles, demand for medical marijuana in Germany has outpaced lawmakers’ expectations.
Fighting for my medicine
I have been receiving medical cannabis from my doctor since 2012 and was the holder of an exceptional permission. Until the recent law change, I was permitted to purchase up to 90 grams of cannabis per month from the pharmacy. At a price of 15 Euro/gram, I could not always afford this, but I still fulfilled my therapy as best as I could with what pharmaceutical cannabis I could afford from the pharmacy.
In March, shortly after the law took effect, I was issued a “private prescription” and filed an application for reimbursement from my insurance company simultaneously. I needn’t pay an “insurance prescription” at the pharmacy, but my doctor might have been responsible for paying 2,052 Euro in case my reimbursement application was rejected.
Because of these concerns, my doctors also issued me a “private prescription,” allowing me to legally obtain cannabis. But when I sought to redeem my prescription in March, I learned of the significant price increase to 23.80 Euro/gram in my pharmacy. Thus, I hoped my insurance would approve my application for reimbursement. After all, I have suffered chronic pain since my childhood, and neither my doctors nor the physicians of the BfArM ever doubted my need because of the long-term documentation of my case. But to my surprise, my insurance rejected my reimbursement in April and passed the case to the Medical Service of the Health Insurances (MDK) for examination and a final decision.
The MDK did not examine or question me. After two weeks, I received the official medical decision: My three doctors were all wrong and I could manage quite well without medical cannabis. Meanwhile, I had been on illegal sources of cannabis for six weeks. My only remaining option was to consult my lawyer who recommended filing a medical emergency-suit against my insurance provider. Four weeks later, and after numerous declarations of opinion and expert opinions, the insurance company was instructed to pay for my medicine forthwith.
My insurance will now pay the cost of 90 grams of cannabis per month until December 2017 or until the judge rules in the main hearing, which could take place anywhere from two months to two years. The main hearing will determine whether or not the health insurance company will continue paying the cost to treat my chronic disease beyond 2017.
To pay 150 or 2,050 Euro?
Many cannabis patients, including myself, submitted home cultivation applications to the BfArM. However, more than 130 applicants were threatened with a high processing fee if they did not revoke their application form when the new medical cannabis law came into force. My monthly therapy costs for self-cultivation would hover around 150 Euro, while my monthly therapy expense with cannabis obtained from my pharmacy would exceed 2,052 Euro. The same amount of the same medicine would cost between 500 and 600 Euro in Dutch pharmacies or in Canada. Currently, more and more patients are filing similar lawsuits against health insurance companies, which are opposed to medical cannabis despite a clear law. It should not be the responsibility of insurance companies to prescribe or impede the therapy of their patients. Their role is to negotiate with producers, wholesalers, and pharmacies in order to guarantee a reasonable price policy. Currently, patients are suffering from rates nearly 400% higher than our EU neighbors, as well as from a law neglecting to keep its promise.