In a significant development in German healthcare, the accessibility of medical cannabis for patients is set to become easier. This move follows a directive from the German Federal Joint Committee (G-BA), tasked last summer with the mandate to define the professional criteria under which medical cannabis can be prescribed without prior approval from health insurance companies.
The push for change has been strong, especially from eight prominent cannabis industry associations, who are now unanimously calling for the complete abolition of the prior authorization requirement.
Background: A Struggle with Bureaucracy
Since March 2017, the prescription of medical cannabis at the expense of the Statutory Health Insurance (SHI) has been possible in Germany. However, the process has been marred by bureaucracy. Initially, each prescription required approval from health insurance companies. While the approval process was streamlined with a two-week deadline (four weeks if an expert opinion was needed), thanks to the Medicinal Product Supply Shortage and Supply Improvement Act (ALBVVG), challenges persisted.
In cases where the criteria were met, health insurance companies could only deny cost coverage in exceptional circumstances. Yet, reports suggest that 30 to 40 percent of prescriptions were denied coverage, leading many patients to resort to illegal means to obtain cannabis.
The G-BA Proposal: A Step Forward
Responding to these challenges, the G-BA was commissioned to define specific qualifications for various medical specialists, under which the prior authorization would be waived. By November of the previous year, the G-BA proposed guidelines for four leading indications, including neurological/psychiatric and oncological diseases, specifying qualifications for medical specialists to prescribe medical cannabis without insurance approval.
The Cannabis Industry’s Response
The proposal sparked a consultation process, now concluded, involving various cannabis industry associations. These groups, including the Association of Cannabis Supplying Pharmacies (VCA), have long advocated for simplified patient access to medical cannabis. They argue that the current bureaucratic hurdles impede widespread access to medicinal cannabis.
The Call for Inclusion of General Practitioners
A key aspect of the ongoing debate is the role of general practitioners. As the second-largest prescribing group, general practitioners are crucial in providing medical cannabis, particularly in rural areas and in light of the growing shortage of specialists. The industry associations strongly advocate for their inclusion in the list of professionals authorized to prescribe medical cannabis without insurance approval.
The Push for Complete Abolition of Prior Authorization
The overarching goal of these associations is the complete abolition of the prior authorization requirement by health insurance companies. This, they believe, is essential to ensure comprehensive patient access to medical cannabis across Germany.
Looking Ahead: Implications and Expectations
As Germany moves towards these reforms, the focus is on balancing the need for professional medical oversight with the ease of access for patients. The decisions made in the upcoming period will have significant implications not only for patients requiring medical cannabis but also for the healthcare system at large, marking a pivotal moment in the evolving landscape of medical cannabis in Germany.