How European Health Insurances Handle Cannabis Prescriptions

Thanks to its recent legalisation, you can now use medical cannabis for the treatment of various health conditions in multiple countries across the European Union. But even though you can legally use cannabis as a treatment in Europe, you might have to pay for it out of your own pocket because most European health insurances will not reimburse you for its cost.


Which European countries legalised medical cannabis?

Germany legalised the prescription of cannabis for medical purposes back in March 2017. Shortly after the German legalisation of cannabis, a wave of approvals for medical cannabis swept across Europe.

Countries such as Denmark, Austria, Malta, Italy, Portugal, Luxembourg, Estonia, Croatia, Poland, Finland, Greece, Ireland, Norway, Spain, the Netherlands, Belgium, Macedonia, the Czech Republic and the UK have legalised, or are currently considering legalising, cannabis for medical purposes.

Despite the recent wave of legalisation, in Europe, access to medical cannabis appears to be provided through exceptional use programmes. A common feature of these programmes is a specialised prescriber who can prescribe cannabis preparations.

There is a wide variation in how each programme is implemented at a national level because each country sets its own rules and procedures for prescribing cannabis preparations to patients.

It’s important to note that all the countries that approved cannabis-based medicines prohibit the smoking of cannabis for medical purposes because of the health risk smoking poses, especially if cannabis is combined with tobacco.


The use of medical cannabis is legal but not authorised

You might be wondering why more physicians are not prescribing cannabis since the substance is now legal. Well, despite the fact that the use of medical cannabis is legal in most of Europe, the substance is not authorised as a medical treatment in some countries.

In the EU, medicines can be authorised in three ways. The first is a centralised procedure that allows EU-wide authorisation for a pharmaceutical drug. This procedure is compulsory for innovative medicines and new substances recommended for major therapeutic areas such as cancer, AIDS, autoimmune diseases, viral diseases and rare diseases.

The second way is a decentralised procedure in which companies can apply for the authorisation of a new product in one or more EU states, and the third way is a procedure in which companies apply for their authorisation in an EU state after their product is already recognised by another EU member state.

To date, except for Acomplia, a medicine that acted as an inverse agonist of the CB1 receptor but was withdrawn from the market in 2008, no EU-wide authorisation has been granted for products containing cannabis or cannabinoids. This means that each company selling cannabis-based medicine has to gain the approval of the Medicines Agency of each country for authorisation.

Nowadays, there is an EU-wide authorisation application under review for a product containing cannabidiol (CBD), but nothing related to medical cannabis.

So, what does that mean for you, the end user?

Well, unless you live in one of the few countries — Austria, Germany, Italy, Portugal, Spain, Poland, the Czech Republic, the UK and Finland — that legalised and authorised the use of cannabis-based medicine, you might not be able to benefit from a cannabis treatment or you might have to pay for it out of your own pocket.


Why most health insurance providers do not reimburse cannabis prescriptions

As you could see in the previous section, authorising the use of cannabis-based medicine is a lengthy process. However, more and more physicians across Europe are starting to prescribe cannabis as medicine.

Many pharmaceutical schemes in EU countries allow patients access to unapproved medicine under medical supervision. These schemes are generally used by patients who suffer from serious, sometimes terminal, illnesses.

Under these schemes, the medical practitioner can prescribe medicines that are undergoing clinical trials or that have been approved in other EU member states.

Sometimes, the pharmaceutical company that produces the cannabis-based medicine offers it to the patient at no cost on compassionate grounds. Other times, the company provides the medicine with the condition of having access to the patient outcomes and adverse event reports.

Most of the time, however, the patient has to support the cost of the medicine because health insurance providers do not reimburse the costs of unapproved medicines.


Health insurance providers that cover cannabis expenses

The public German health insurers cover the cost of medical cannabis for patients who have exhausted other treatment options. A report presented in 2018 by the German newspaper Rheinische Post showed that about 13,000 patients received reimbursements for cannabis products while over 7,000 claims were rejected.

Patients in the Netherlands, the UK, Italy, Luxembourg and Austria can get reimbursements for their cannabis-based treatment. However, most public health insurers will only cover the cost of medical cannabis if the patient exhausted other treatment options.


The future of cannabis prescriptions in Europe

Thanks to the recent wave of legalisation across the world, scientists can now research the effects of cannabis-based medicine on human health. Since recent studies show that cannabis and cannabinoids can help with a wide variety of medical conditions, the future of cannabis seems destined for greatness.

At the moment, each European country has a different approach to cannabis. Time will tell how European nations will handle cannabis prescriptions in the future.


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