The Federal Joint Committee (G-BA) has announced new regulations that detail the exceptions to the approval requirements for the prescription of medical cannabis. Currently, the initial prescription of cannabis products typically requires approval from the health insurance provider, with subsequent approvals needed only in cases of a product change.
The G-BA has now specified the qualifications of prescribing physicians under which the need for insurance approval is waived: the list includes 16 specialist and sub-specialist titles, as well as 5 additional designations such as palliative care and special pain therapy. According to the G-BA, physicians holding these specialist, sub-specialist, or additional designations are deemed capable of independently assessing the appropriateness of a cannabis prescription. However, in cases of uncertainty, these qualified physicians may still seek approval from the health insurance provider.
Medical Cannabis Decision: Balancing Bureaucratic Efficiency and Patient Safety
Prof. Josef Hecken, the impartial chairman of the G-BA and chairman of the subcommittee on pharmaceuticals, commented on the decision: “We did not take the implementation of this legal mandate lightly. Determining which medical qualifications allow for the complete waiver of the insurance approval requirement for a cannabis prescription was challenging. We received valuable feedback on our initial resolution draft, which has been incorporated into the final decision. To avoid confusion, no specific diseases are mentioned, as the approval waiver applies broadly. Moreover, the listed specialist and sub-specialist titles do not require additional training. I believe we have found a balanced solution that significantly reduces bureaucratic burden without compromising patient safety.”
A prescription for medical cannabis is generally only possible if other treatments that could positively influence the disease progression or alleviate severe symptoms are not available, and if there is a potential positive effect from cannabis medications.
New Regulations Aim to Streamline Medical Cannabis Prescriptions and Reduce Administrative Hurdles
Health insurance providers may evaluate these criteria differently than treating physicians. Therefore, even adequately qualified physicians may opt to seek approval from the health insurance provider to avoid financial recourse from the insurance (regress). However, this approval process does not include a final assessment of whether a more economical cannabis product could have been chosen.
Legally insured patients are entitled to a prescription for cannabis under specific conditions: this includes dried flowers, extracts, and medications containing the active ingredients dronabinol or nabilone. The Act to Combat Drug Supply Shortages and Improve Supply (ALBVVG) tasked the G-BA with defining the specific specialist groups and required medical qualifications for which the insurance approval requirement is waived.
This new regulation is expected to streamline the process of prescribing medical cannabis, reduce administrative hurdles, and ensure that patients receive timely and appropriate care based on the latest medical expertise.
Resource: Federal Joint Committee, July 18, 2024
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