Berlin, 2026-04-29: The leading professional associations in the field of medical cannabis strongly oppose the removal of reimbursement eligibility for medical cannabis flowers under Section 31 (6) SGB V, as provided for in today’s cabinet decision of the federal government on the statutory health insurance contribution rate stabilization law.

The planned regulation, according to which only cannabis extracts, finished medicinal products, as well as dronabinol and nabilone will remain reimbursable at the expense of statutory health insurance in the future, is assessed by the associations as risky in terms of healthcare policy, legally problematic, and not viable from a health economics perspective.

Targeted exclusion of benefits instead of efficient regulation

The entitlement under Section 31 (6) SGB V is already strictly limited today. Cannabis medicines are prescribed exclusively for serious illnesses and only when recognized standard therapies are not available or are ineffective or not tolerable in individual cases. The planned removal would therefore not affect a broad group of insured persons but would specifically impact particularly vulnerable, chronically seriously ill, and in some cases palliative patients.
“For many seriously ill patients, cannabis flowers are not a ‘lifestyle product’ but the therapy that enables them to regain a degree of quality of life. Removing this option from reimbursement not only deprives patients of a medication but forces them either to discontinue therapy or to pay out of pocket – for many simply not a realistic alternative,” emphasizes Daniela Joachim, representing cannabis patients in the German Cannabis Patients Association (BDCan).

Therapeutic equivalence not given

The assumption that cannabis flowers can be therapeutically replaced by extracts or finished medicinal products is unanimously rejected by the associations. In practice, there are relevant pharmacokinetic differences: in particular, the rapid onset of effect of inhaled cannabis flowers is medically necessary for certain indications – such as acute pain peaks, spasticity, nausea, or migraine attacks – and cannot be adequately substituted by orally administered preparations.
Supply data from the accompanying survey initiated by the legislator itself also show that cannabis flowers in practice are associated with lower therapy discontinuation rates and fewer reported side effects than other cannabis medicines. This argues against their blanket removal from the benefits catalog.
“Cannabis flowers are medically not replaceable by oral preparations for a relevant proportion of patients. Especially in acute pain peaks or spasticity, the rapid onset of effect is crucial. Removing them worsens care – without medical added value,” criticizes Dr. med. Franjo Grotenhermen, Chairman of the Working Group on Cannabis as Medicine (ACM).

Addiction and standardization arguments not evidence-based

The increased addiction risk cited in the draft bill due to the rapid onset of inhalative application is assessed by the associations as not scientifically substantiated. Data from physician-supervised care show abuse or addiction developments only in a negligible proportion of cases.
The frequently cited argument of insufficient standardization also falls short in the view of the associations. Medical cannabis flowers are subject to strict GACP and GMP standards and have defined active ingredient contents as well as narrowly limited tolerance ranges. Minor natural fluctuations are clinically irrelevant and established in medical practice.
“Supply with medical cannabis flowers today takes place through established, highly qualified pharmacy structures with special quality, documentation, and counseling processes. These structures have been built over years and ensure responsible, controlled, and professional care. Their devaluation through a blanket exclusion of benefits is short-sighted in terms of healthcare policy,” explains Dr. Christiane Neubaur, Managing Director of the Association of Cannabis-Supplying Pharmacies (VCA).

No relevant savings potential – significant downstream risks

From the perspective of the associations, the savings potential mentioned in the cabinet draft is not proportionate to the expected consequences for care. The calculation does not take into account shifts to more expensive finished medicinal products nor additional costs due to therapy changes or consequential damage.
As many seriously ill patients cannot afford out-of-pocket payments, there is also a risk of treatment discontinuation or a shift to unsafe procurement channels, which would counteract the healthcare policy objectives of cannabis legislation.
“The alleged savings potential is methodologically not robust. In reality, cost shifts, therapy discontinuations, and new risks are looming – at the expense of patients and ultimately also at the expense of the healthcare system,” warns Dirk Heitepriem, President of the German Cannabis Business Association (BvCW).

Interference with medical therapeutic sovereignty and constitutional concerns

The associations see the planned regulation as a systematic break with the legal concept in place since 2017 as well as with supreme court case law on individual therapeutic alternatives. A blanket exclusion of a form of administration directly interferes with physicians’ therapeutic sovereignty.
In addition, from the perspective of the alliance of associations, the planned removal of reimbursement eligibility for cannabis flowers raises significant constitutional questions. If seriously ill patients are denied access to an effective therapy solely for fiscal reasons, there is a risk of violating the fundamental right to physical integrity (Art. 2 (2) sentence 1 GG) as well as constitutionally required protection of legitimate expectations.
“The planned regulation assumes therapeutic interchangeability that is neither evidence-based nor legally sustainable. It contradicts the intention of Section 31 (6) SGB V and supreme court case law,” clarifies Antonia Menzel, Chairwoman of the German Association of Pharmaceutical Cannabinoid Companies (BPC).

Demand of the alliance of associations

The signing associations call on the federal government not to pursue the planned removal of cannabis flowers from statutory health insurance reimbursement.
Instead of a blanket exclusion of benefits, a differentiated, evidence-based further development of care is required that equally takes into account therapeutic reality, patient safety, and economic efficiency.