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Educational platform on topics related to the German cannabis industry.
Approval by the health insurance company
When prescribing for the first time, approval must first be obtained from the insured person’s responsible health insurance company.
You can have the application personalized using our patient quiz:
https://www.cannabis-aerzte.de/cannabisantrag/
Decision deadlines
The health insurance company must have decided on the application no later than three weeks after receipt of the application.
In cases where the health insurance company considers an expert opinion from the medical service to be necessary, this period is extended to a maximum of five weeks after receipt of the application.
For patients who are in specialized outpatient palliative care according to Section 37b SGB V, the approval period for the health insurance company is shortened to three days (Section 31 Paragraph 6 Sentence 3 SGB V).
Reasons for rejection
The law also stipulates that the health insurance company may refuse approval “only in justified exceptional cases ” .
The treating physician plays a crucial role in the medical cannabis treatment process. Their primary responsibilities include:
Cannabis-containing medicines that can be prescribed vary depending on the country and its regulations. However, some of the most commonly prescribed cannabis-based medicines include:
2. Cannabis-Based Medicines Available in Some Countries:
3. Medical Cannabis (Varies by Region)
For medical cannabis consultations, doctors need to inform patients about several key aspects to ensure safe and effective use. These include:
1. Medical Information
Purpose & Benefits: Why the cannabis-based medicine is prescribed and how it may help their condition.
Dosage & Administration: How much to take, how to take it (oil, capsule, inhalation, etc.), and timing.
Expected Effects: How soon the effects will appear and how long they will last.
2. Safety & Side Effects
Common Side Effects: Drowsiness, dry mouth, dizziness, changes in appetite, mood changes, etc.
Potential Risks: Possible interactions with other medications, risk of dependency, and mental health effects (e.g., anxiety, paranoia).
Driving & Work Restrictions: Laws about driving or operating heavy machinery while using medical cannabis.
3. Legal & Regulatory Information
Local Laws & Compliance: Whether medical cannabis use is allowed in their area and any restrictions.
Travel Restrictions: Rules about carrying cannabis-based medicine across state or country borders.
The German Federal Institute for Drugs and Medical Devices (BfArM) previously granted exemptions (§3(2) BtMG) for patients to obtain medical cannabis before the Cannabis as Medicine Act (2017) was introduced. However, since the law took effect on March 10, 2017, these exemptions became obsolete because:
Medical Cannabis Became a Regular Prescription Medicine
Patients no longer need a special permit from BfArM.
Instead, they receive cannabis-based medicines through a doctor’s prescription.
Health Insurance Coverage
Patients can apply for reimbursement through statutory health insurance, although approval is not guaranteed.
Pharmacy Dispensing
Medical cannabis is now legally obtained from pharmacies under prescription, ensuring standardized quality and legal security.
Exceptions & Current Regulations
Clinical Studies & Research: BfArM still plays a role in approving cannabis-related clinical studies.
Cultivation Licenses: BfArM regulates domestic medical cannabis production and oversees its distribution.
Common Conditions for Cannabis Prescription
Doctors can prescribe cannabis for patients suffering from:
1. Chronic Pain & Neurological Disorders
Chronic pain syndromes (e.g., neuropathic pain, fibromyalgia)
Multiple sclerosis (MS) (spasticity, muscle stiffness, pain)
Epilepsy (especially treatment-resistant epilepsy)
Parkinson’s disease (tremors, stiffness)
2. Cancer & Palliative Care
Cancer-related pain
Nausea & vomiting from chemotherapy
Loss of appetite & weight loss (cachexia)
3. Mental Health & Neurological Disorders
Anxiety disorders (select cases)
PTSD (Post-Traumatic Stress Disorder)
Tourette syndrome (tics)
4. Gastrointestinal & Autoimmune Diseases
Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
HIV/AIDS-related weight loss & appetite loss
For privately insured patients in Germany, the requirements for prescribing medical cannabis differ slightly from those with statutory health insurance (GKV). Here’s what applies:
1. Prescription Process
A doctor (any specialty) can prescribe medical cannabis if they believe it is medically necessary.
No special approval from private insurance is required before prescribing.
Prescriptions follow the Narcotics Prescription Ordinance (BtMVV) and must be written on a special narcotics prescription form (BtM-Rezept).
2. Cost Coverage by Private Health Insurance
Private insurance companies are not legally required to cover cannabis prescriptions.
Reimbursement depends on the contract with the insurance provider. Some insurers cover cannabis like other medicines, while others require proof of necessity.
If rejected, patients must pay out of pocket at the pharmacy.
3. Additional Documentation (If Required by Insurer)
Some private insurers may request:
A detailed medical report explaining why cannabis is needed.
Proof that other treatments have failed or have severe side effects.
Sometimes, a cost estimate from the pharmacy for approval.
Medical cannabis can be prescribed by:
1. Licensed Physicians
Any doctor (except dentists and veterinarians) can prescribe medical cannabis.
No special certification is required, but they must follow medical guidelines.
2. Specialists Who Commonly Prescribe Cannabis
Some specialists are more likely to prescribe cannabis due to the conditions they treat:
Pain Specialists & Anesthesiologists → Chronic pain, fibromyalgia
Neurologists → Multiple sclerosis, epilepsy, Parkinson’s, Tourette’s
Oncologists → Cancer pain, chemotherapy-induced nausea
Palliative Care Doctors → End-of-life care, severe chronic illnesses
Psychiatrists → PTSD, anxiety disorders (in rare cases)
Gastroenterologists → Crohn’s disease, ulcerative colitis
3. Important Prescription Rules
Doctors must justify the prescription (cannabis is only prescribed when other treatments fail or cause side effects).
BtM Prescription Required: Cannabis is classified as a narcotic (BtM – Betäubungsmittel) and must be prescribed on a special yellow narcotics prescription form (BtM-Rezept).
Health Insurance Approval (for GKV patients): Statutory health insurance patients need approval before starting treatment.
Medical cannabis can be prescribed for various illnesses when standard treatments are ineffective or cause severe side effects. The exact conditions depend on doctor’s discretion and legal regulations in each country.
1. Chronic Pain & Neurological Disorders
Chronic pain syndromes (e.g., neuropathic pain, fibromyalgia)
Multiple sclerosis (MS) (spasticity, muscle stiffness, pain)
Epilepsy (especially drug-resistant forms)
Parkinson’s disease (tremors, stiffness, movement issues)
Tourette syndrome (to reduce tics in severe cases)
2. Cancer & Palliative Care
Cancer-related pain
Nausea & vomiting from chemotherapy
Appetite loss & weight loss (cachexia)
3. Mental Health & Psychiatric Disorders
Post-Traumatic Stress Disorder (PTSD)
Severe anxiety disorders (in some cases)
Depression (limited cases, still under research)
4. Gastrointestinal & Autoimmune Diseases
Inflammatory bowel disease (IBD) (Crohn’s disease, ulcerative colitis)
Irritable bowel syndrome (IBS) (in some cases)
5. HIV/AIDS & Other Conditions
HIV/AIDS-related appetite loss & weight loss
Glaucoma (reducing intraocular pressure, though rare today)
Severe migraines (in resistant cases)
Prescription Criteria
Doctors prescribe cannabis only when other treatments fail or cause intolerable side effects.
Prescription is on a BtM (narcotic) prescription in Germany.
Statutory insurance (GKV) requires pre-approval, while private insurance depends on the contract.
As a medical cannabis patient , you can still drive legally, but there are important rules and risks to consider.
1. Driving Legally as a Cannabis Patient
Medical cannabis patients are allowed to drive if they are not impaired.
Regular use under doctor’s supervision is different from recreational use.
THC blood levels are not automatically a problem for patients with a valid prescription.
2. Police Checks & THC Limits
If the police suspect impairment, they may test for THC in blood.
There is no fixed THC limit for medical patients, but impairment is key.
If you appear intoxicated (e.g., slow reactions, red eyes), you can lose your license.
3. Medical Proof Required
If stopped by police, you should carry:
Cannabis prescription or doctor’s note
Pharmacy receipt (if available)
In case of a legal issue, a medical report proving regular use may help.
4. Driving License Office (Führerscheinstelle) Issues
If authorities question your ability to drive, they may require a Medical-Psychological Assessment (MPU).
A stable, medically supervised therapy is key to avoiding problems.
5. Important Warnings
No driving under the influence: Wait at least 4-6 hours after inhaling cannabis.
New patients should avoid driving until they understand how cannabis affects them.
Mixing cannabis with alcohol or other drugs can cause serious legal problems.
Yes, cannabis therapies can be limited in time, depending on the patient’s condition, treatment goals, and doctor’s evaluation.
1. Temporary vs. Long-Term Therapy
Short-Term Therapy:
Used for acute conditions like chemotherapy-induced nausea or post-surgical pain.
Doctors may prescribe cannabis for a specific period and reassess.
Long-Term Therapy:
Chronic illnesses like multiple sclerosis, chronic pain, or epilepsy may require continuous treatment.
Doctors conduct regular evaluations to check effectiveness and side effects.
2. Prescription Review & Continuation
Doctors typically review cannabis prescriptions every 3 to 6 months.
Insurance-covered patients may need to renew approvals after a certain time.
If the patient improves or alternative treatments become available, cannabis therapy may be stopped.
3. Dose Adjustments & Weaning Off
Some patients may need dose reductions over time.
If stopping treatment, doctors often recommend a gradual reduction to avoid withdrawal symptoms.
In Germany, vaporizers for medical cannabis are generally not covered by statutory health insurance (GKV), but there are some exceptions.
1. Statutory Health Insurance (GKV) Rules
Vaporizers are considered medical devices, but they are not automatically reimbursed.
Exceptions: Some patients have received cost coverage if they prove:
Inhalation is the only effective method for their condition.
Other forms (oils, capsules) are not suitable due to medical reasons.
A doctor provides a detailed justification for the vaporizer.
2. Private Health Insurance (PKV)
Coverage depends on the individual insurance contract.
Some private insurers may reimburse vaporizers if a doctor certifies their medical necessity.
3. Alternative Funding Options
Patients can apply for financial support from foundations or special health programs.
Some pharmacies and manufacturers offer discounts or financing plans.
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