On 7 October the Bundestag Health Committee is examining a CDU/CSU and SPD amendment that tones down one of the most contested parts of Germany’s medical cannabis reimbursement reform: the mandatory six-month trial with a licensed medicine before extracts can be prescribed on public health insurance. Flower, however, stays outside coverage.
What Germany passed in July
The change came inside a health-spending package, the statutory health insurance contribution stabilisation act (BStabG), passed on 10 July and in force since 29 July 2026. It had two direct effects on medical cannabis:
- Dried flower was removed from statutory health insurance (GKV) coverage. It can still be prescribed, but patients pay for it. According to Business of Cannabis, around 65,000 patients lost reimbursement.
- Standardised extracts and preparations with dronabinol or nabilone are only reimbursed after at least six months of treatment with an already licensed cannabis medicine.
The controversy: a rule with a name on it
The six-month trial was added late in the legislative process and quickly drew criticism for favouring one product. Vertanical’s Exilby is a plant-derived extract licensed for chronic lower back pain with a neuropathic component, and it is the only cannabis medicine approved in Germany specifically for pain. In practice, the rule made it a mandatory first step for chronic pain patients. The case sparked a debate about industry influence over the wording of the law, which ended up weighing on the coalition’s decision.
What the amendment changes
According to Pharmazeutische Zeitung, the amendment is attached to the emergency care reform and changes the rule in two ways:
- Indication only. The licensed medicine takes priority only when the patient has the indication that product is approved for. Outside it, doctors can prescribe the extract without first going through the finished medicine.
- No fixed period. The six months disappear from the law. Doctors will decide, on clinical grounds, how long a reasonable therapy trial should last.
What does not change: flower remains excluded from public reimbursement, and the priority principle for licensed medicines stays, though with a much narrower scope.
Business implications
- Extracts are the reimbursable route. With flower out of the GKV, producers and labs with EU-GMP standardised extracts gain weight in the insurance-funded channel.
- Flower moves to private pay. Flower volumes into Germany will depend on self-paying patients and telemedicine, in a market already under price pressure.
- Regulatory risk. In barely three months a key rule has been passed and corrected. Anyone planning exports to Europe’s largest market should expect fast changes and follow the Bundestag process closely.
- A lesson for Spain. Spain’s Royal Decree 903/2025, one year old today, is also built around standardised extracts and hospital dispensing. Germany’s reimbursement experience will be a reference point in the review planned by the Spanish Health Ministry.
Discuss it in Bilbao
Reimbursement, extracts versus flower and access to the German market will be on the table at Spannabis B2B Bilbao 2027, on 11 March in the VIP Hall of the BEC. If you export or want to enter the European supply chain, get your ticket or book a B2B table to meet distributors, labs and investors from the sector.