Germany Ends Insurance Cover for Medical Cannabis Flower

Germany’s public health insurance will stop paying for medical cannabis flower, and the patients who depend on it — many of them seriously ill — now face a choice between switching to costlier products or paying out of pocket.

The change sits in a sprawling cost-cutting package for the statutory health system, which the Bundestag approved on July 10, 2026 and the upper chamber cleared the same day. Cannabis occupies a single clause in a law otherwise built to close a multibillion-euro hole in insurance finances. But for the roughly 65,000 people whose cannabis therapy is currently reimbursed, it is the most consequential line in the bill.

What the law changes

Two things happen at once. Dried cannabis flower drops out of the benefits that statutory insurers must cover, placed by the government in the same category as homeopathic remedies, which the savings law also strikes. And the extracts and oils that remain reimbursable now come with a waiting period: before an insurer will pay for a compounded cannabis preparation, the patient must first complete a documented six-month trial of an approved, licensed cannabis medicine, with the insurer’s sign-off required before treatment begins.

That second requirement was not in the government’s original draft. It surfaced as a late amendment from the governing coalition days before the vote, and it reshapes how doctors will have to prescribe. Only four licensed cannabis medicines exist in Germany: Sativex for multiple-sclerosis spasticity, Epidyolex for rare epilepsies, Canemes for chemotherapy-induced nausea, and Exilby, the Vertanical extract approved in June 2026 for chronic back pain.

The problem is that most patients do not fit those labels. In the drug regulator’s own patient survey, more than three-quarters cited chronic pain as their main condition, and the only licensed product that treats pain, Exilby, is still negotiating a reimbursement price and is not yet sold on the covered market. For everyone else, the mandatory trial means six months on a medicine that is not approved for their illness, an off-label use that requires separate justification and individual approval from the insurer.

A savings law that may cost more

The Branchenverband Cannabiswirtschaft, the sector’s main trade association, argues the arithmetic does not hold. Flower is the cheapest cannabis medicine per milligram of THC, so pushing patients onto standardized extracts or licensed products tends to raise the bill for the same dose rather than lower it. The association says the reform “completely misses its actual objective,” and warns that curbing doctors’ freedom to prescribe will send some patients back to the illicit market they left when they obtained a prescription.

The numbers give critics room. Statutory insurers spent about €205 million on medical cannabis in 2025, flower and extracts combined, a small figure against a structural funding gap the government projects could reach €40 billion by 2030. The government estimated that dropping flower would save around €130 million in 2027, climbing in later years. The health ministry defends the cut on medical grounds, arguing that the rapid onset of inhaled cannabis carries a higher risk of dependence in long-term use and that licensed, standardized medicines are the more evidence-based option.

Patient advocates counter that flower is exactly what some seriously ill people cannot do without. For acute pain or spasticity, the fast relief of inhalation has no oral equivalent, and the regulator’s survey found that patients on flower dropped out of treatment far less often than those on extracts or pure-cannabinoid drugs. The law offers no protection for patients already stable on their current therapy.

What happens next

For once in German lawmaking, there is no further procedural off-ramp. The measure did not require the consent of the Bundesrat, and although several states — among them Bremen, Hamburg and Lower Saxony — pushed to send it to a mediation committee for revision, that motion failed. The parliamentary process is finished, and the law takes effect largely once it is published, with some provisions following in 2027 and 2028.

What remains open is the fine print. The federal body that governs reimbursement rules, the joint committee of doctors and insurers, still has to spell out how the six-month trial and its exemptions will work in practice. Vertanical’s price talks over Exilby will decide whether pain patients — the largest single group — have any licensed gateway drug at all. And the industry has flagged constitutional concerns about stripping coverage from patients mid-treatment, a signal the fight is likely to move from parliament to the courts.

The shift fits a wider pattern. Berlin has spent the past year tightening the rules around medical cannabis, from telemedicine prescribing to import compliance, and this latest measure narrows the field again, this time at the point where it matters most to patients: the pharmacy counter.