German Patient Wins Legal Battle to Have Medical Cannabis Costs Covered by Insurance

Soft Secrets
15 Oct 2020

It's great news for patient access to medical cannabis and the right to have costs for treatment covered by health insurance. 

Insurance policies are known to be selective when it comes to covering medical costs. A German patient was prompted to take her health insurer to court so that she can reimburse expenses on medical cannabis she uses for treating a serious condition. Thankfully, the court ruled in favor of the patient.

The Social Court of Berlin and Brandenburg ruled recently that the health insurance provider must cover the cost of dronabinol drops for the patient for at least one year, according to Marijuana Business Daily. That the woman had to take her insurer to court is proof that patients often need to fight their insurance companies for having the costs for their medical cannabis covered.

Even in countries like Germany, where a national program on medical cannabis foresees for insurers to offer reimbursements, active since 2017, insurers have rejected roughly 40% of reimbursement applicants. Insurers have the right to reject the coverage in exceptional cases, however, in the case of the German patient who went to court, the underlying condition is serious.

"It is undisputed that the applicant has a serious illness" with a significant effect on her quality of life, the Social Court of Berlin and Brandenburg ruling said, reports Marijuana Business Daily.

Denying the patient coverage for medical cannabis costs is violating their fundamental rights, the ruling said.

The patient has been described to receive a disability pension as she suffers from a very pronounced restless leg syndrome, a condition that causes an uncontrollable urge to move your legs and is suspected to be caused by an imbalance of the brain chemical dopamine. The patient also struggles with insomnia and dream-disturbed sleep, chronic pain, migraine, depression, and emotional instability.

According to the ruling, the restless leg syndrome alone, also known as Willis-Ekbom disease, would fulfill the requirement of "serious illness." It's one of the three major requirements, in line with German law, which mandates when statutory health insurers must cover the cost of medical cannabis. The other two requirements are that medical cannabis is used as a last resort and that the patient shows an improvement in their condition from taking the medicine.

The ruling said that the patient's suffering, who lives on social benefits, is serious and that dronabinol administration may improve her condition in the future. Denying her coverage of dronabinol would violate her fundamental rights, the ruling said

Consequently, the court ruled that the health insurer must pay for dronabinol treatment for the patient for a one-year period. The ruling said that during this period, "it will be found out whether the administration of dronabinol has a noticeable positive effect on the course of the disease or serious symptoms."

If the treatment is successful within one year, the insurer will have to ensure the patient is "supplied with dronabinol beyond the one-year period."

The insurer must now also cover the patient's judicial costs for the case, among other things. 

What is Dronabinol?

Dronabinol is a derivative of THC, the primary psychoactive chemical compound found in cannabis. The drug is used to treat various symptoms and conditions, including loss of appetite and weight loss in AIDS patients or severe nausea and vomiting caused by cancer chemotherapy. 

Dronabinol can only be prescribed to persons older than 18 years. Only a doctor can prescribe dronabinol, and the medicine must be taken exactly as instructed. 

It's available in capsule form as well as liquid, taken with a glass of water.

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