Since late July, Germany’s statutory health insurance (GKV) no longer pays for dried medical cannabis flower. The law behind the change included no transition period and, three months on, the issue is being fought in the social courts. Last week the Federal Constitutional Court closed the shortcut: it refused to hear a patient’s complaint and told them to go through the ordinary courts first.
What changed and who is affected
The GKV-Beitragssatzstabilisierungsgesetz, a health-spending containment law, removed flower from Section 31(6) of the Social Code (SGB V), the legal basis for reimbursement. According to Business of Cannabis, around 65,000 patients are affected. Extracts remain reimbursable, but for new treatments the law required a six-month trial of an approved cannabis-based finished medicine first.
That requirement has been softened. On 15 October the Bundestag passed an amendment under which the prior trial only applies if a licensed medicine exists for the indication, with its duration left to the physician. The amendment does not restore flower reimbursement. The Bundesrat is expected to discuss it on 20 November, but because the law does not require its consent, it can only delay it.
The courts disagree
The first rulings, all in emergency proceedings, point in opposite directions, as an analysis in Legal Tribune Online sets out:
- Frankfurt (21 August) and Leipzig (16 September) rejected the applications: with flower gone from Section 31(6), there is no legal basis to keep paying, even where the insurer had granted open-ended approval.
- Dresden (28 August) ruled for the patient: a final earlier approval stays in force until the insurer expressly revokes it.
- Landshut (8 September) followed the same line: an objection against the revocation suspends it, so coverage continues while the objection is decided.
None of these decisions binds other courts, and several are under appeal before the higher social courts of Hesse and Saxony. Until there is second-instance case law, a patient with an older approval faces a different outcome depending on where they live.
First effects on the market
The change already carries a business cost. Business of Cannabis links the reform to the insolvency of Lux 99, a specialist pharmacy in Hürth that filed on 24 October. It also notes that softening the six-month trial removes much of the flow of new chronic-pain patients that the original law pushed towards Exilby, Vertanical’s medicine launched on 1 September at €745.40 per pack.
For the rest of the supply chain, flower in Germany now depends on self-paying patients and private prescriptions, including telemedicine, which lawmakers are also targeting. Extracts gain weight within the reimbursed channel.
What companies should watch
- Producers and importers supplying Germany, including EU-GMP certified growers in Spain and Portugal: review flower volume forecasts and the share of extracts in the portfolio.
- Distribution and pharmacies: the self-pay channel rewards competitive pricing and service, not just availability.
- Investors: the legal timeline is long. A final answer could take years if a case climbs all the way to Karlsruhe.
- Dates ahead: the Bundesrat session on 20 November and the rulings of the higher social courts in Hesse and Saxony.
We covered how the reimbursement reform took shape earlier; the uncertainty is now a legal one.
The German market, on the table in Bilbao
Germany is still the leading destination for European medical cannabis, and its reimbursement rules shape production plans across the EU, Spain included. At Spannabis B2B Bilbao 2027, on 11 March in the VIP Hall at BEC, producers, importers and distributors will see how partners and clients are adapting. Get your ticket or book a B2B table to set up meetings with the German market.