A German patient won a long legal battle against her statutory health-insurance provider involving medical cannabis reimbursement.
The Social Court of Berlin and Brandenburg ruled that the health insurer must cover the cost of dronabinol drops for at least one year.
The news is positive for patient access to medical cannabis and companies looking to capitalize on the burgeoning market.
But the court case affirms that patients often need to fight their insurance companies for cannabis reimbursement – even though the German medical marijuana program that mandates such coverage has been active for years.
Insurers may reject treatment only in “justified, exceptional cases” but as Marijuana Business Daily exclusively reported, almost 40% of the applications for reimbursement have been rejected by insurers since the start of the program in 2017.
“It is undisputed that the applicant has a serious illness” with a meaningful effect on her quality of life, according to the Social Court of Berlin and Brandenburg’s recent ruling.
The patient, who receives “a disability pension … suffers from a very pronounced restless legs syndrome with massive sleep disorders, chronic pain disorder with somatic and psychological factors, migraine, recurrent depressive disorder, emotionally unstable personality disorder (borderline) and tinnitus.”
The restless leg syndrome alone would fulfill the requirement of a “serious illness,” according to the ruling.
“The suffering of the applicant living on social benefits is serious,” and denying her coverage of dronabinol would violate “her fundamental rights.”
So the court ruled that for a one-year period, the health insurer must pay for dronabinol treatment for the patient.
The German law amendment of early 2017 mandated that statutory health insurers cover the cost of medical cannabis, provided:
- The patient is seriously ill.
- Cannabis is used as a last resort, considering the possible side effects.
- It is likely cannabis will provide a positive effect to treat the disease or its symptoms.
The insurer also must reimburse the applicant for the judicial costs of the case.
Alfredo Pascual can be reached at firstname.lastname@example.org