Germany Green-Lights Changes to Medical Cannabis Prescription Process

It comes amid reports suggesting the German pharmacies are now key beneficiaries of the medical cannabis market, bringing in tens of thousands of euros every month from medical cannabis sales.

While cannabis cultivation associations are also expanding rapidly across the country, not everyone is so thrilled about the recent changes, with a new YouGov poll suggesting a slim majority of Germans believe partial legalisation was wrong.

Earlier this week, Germany’s Federal Joint Committee’s (G-BA) proposed significant changes to the medical cannabis prescription process, which open the door for medical cannabis to be prescribed via statutory health insurance (gesetzliche Krankenversicherung or GKV), were officially brought into effect.

The G-BA’s decision was published on October 16 in the Federal Gazette, signifying that the law has been formally enacted and is now officially part of the legal system. The Federal Ministry of Health had legally examined the decision and did not object.

Under the new law, a total of 16 specialist and specialty titles, along with five additional titles, have been listed, which the G-BA assumes ‘can conclusively assess the requirements for a cannabis prescription’, and prescribe without health insurance approval.

As stated in Prohibition Partners newly released German Cannabis Report, historically roughly 60% of patients had been private payers and 40% were expensed by statutory health insurance. However, after 1 April 2024, private prescriptions have risen to account for 80% of total prescriptions whereas reimbursable prescriptions have dropped down to 20%.

Under the new regulations, this ratio could change significantly once again, with around 70% of all doctors in the country now being able to prescribe via health insurance without receiving prior approval, a move that could have a ‘major effect on basically the entire German market because suddenly the statutory health insurers are required to pick up the cost of medical cannabis.’

Under certain conditions, those with statutory health insurance, which includes around 90% of the country, are entitled to a prescription for cannabis in the form of dried flowers or extracts, as well as for medicines containing the active ingredients dronabinol or nabilone.

The explosion of Germany’s medical cannabis market and the emergence of a swathe of tele-health clinics are not just lucrative for dedicated cannabis businesses but also for dispensing local pharmacies.

After the passage of CanG, any pharmacy in Germany can dispense cannabis prescribed by doctors either online or in person.

Despite the red tape surrounding dispensing cannabis being significantly reduced following its removal from the list of narcotics on April 01, only around 2500 to 3000 pharmacies currently dispense in practice.

One such pharmacy in Lower Saxony told German media giant Ippen Media, that they now make a gross profit of €50,000 every month.

The owner of easycannabis.de says that around 30kg of cannabis is distributed to patients every month via their mail-order business, making roughly €200 per order.

With costs deducted for personnel and packing material, this means the pharmacy is now making around €30,000 monthly.

While pharmacists may be behind the new lucrative liberalisation of cannabis laws, many in Germany think less highly of the changes.

According to a recent YouGov survey conducted on behalf of the German Press Agency, 31% of the 2100 eligible voters questioned said they had observed an increase in cannabis consumption in their everyday environment.

Furthermore, a majority (55%) thought that partial legalisation was wrong in retrospect, with just 37% thinking it was right.

In a separate survey by the Allensbach Institute for Demoscopy for FAZ, only 34 percent of respondents were in favour of it, while 48 percent answered negatively.

However, the publication noted key disparities between age groups regarding their support for the reform.

Only 28% of respondents under 30 were opposed to the reform, while 54% were in favour. For those aged between 30-40, 47% were in favour of the partial legalisation.

Older voters aged between 45-59 were 49% against, while 62% of those ages over 60 believed the reform was wrong.

The German Police Union (GdP) has also publicly expressed its skepticism over the effectiveness of CanG in reducing the size of the black market, one of the key goals of the reform.

GdP Vice President Poitz criticized the law for lacking state control, stating that it could lead to increased consumption and easier operations for organized crime, as adults can now carry up to 25 grams of cannabis. Despite the reform, Poitz suggested they had seen no significant decrease in black market activity or police workload.

The Federal Ministry of the Interior, however, maintains that the law was designed with security and crime prevention in mind, although the YouGov survey shows 68% of Germans are concerned about youth protection under the new law.

Additionally, the German Judges’ Association warned that the law might complicate the prosecution of large-scale drug crimes. A formal evaluation of the law’s impact is scheduled for 2025, with results expected after the next federal election.

The opposition to the new cannabis laws is more pronounced in some federal states than others.

In Bavaria, the state’s Minister President Markus Söder (CSU) has been open about his intentions to apply the law ‘extremely restrictively’ regarding cannabis, warning citizens before the law had even come into effect that those hoping to consume cannabis would be better off in another state.

With CanG giving states a level of autonomy as to how they regulate the rollout of adult-use cannabis associations, Bavaria has introduced strict measures, imposing fines and bans on consumption in places like outdoor restaurants and festivals.

In response, a cross-party alliance of Bundestag members, including mebers from the SDP, FDP and Left Party, is now suing the Bavarian state government. 

The coalition argues that Bavaria is undermining federal law and violating the Bavarian Constitution and Basic Law by disproportionately restricting citizens’ rights.

SPD politician Carmen Wegge, along with others, plans to present the lawsuit, criticizing Bavaria’s harsh stance as a ‘cultural war’ against progress. The Bavarian Health Minister, Judith Gerlach, remains confident in the constitutionality of the state’s actions, arguing that their restrictive approach is necessary to protect public health, especially for young people.

Meanwhile, cannabis clubs across other states are continuing to be licensed, and some have already finished their first harvests.

Prohibition Partners’ German Cannabis Report, which dives deeper into the issues discussed in this article, is now available to download here.