Germany’s Statutory Health Insurance Reform: Cost-Cutting with Consequences for Medical Cannabis

A broad cost-cutting package with many points of contention

Without additional measures, the German government expects the statutory health insurance system, known as the GKV, to face a funding gap of more than €15 billion in 2027. The legislation is therefore designed to reduce expenditure through a broad package of measures.

These include higher patient co-payments, limits on increases in healthcare remuneration, an additional manufacturer rebate for patent-protected medicines, and the removal of homeopathic and anthroposophic medicines and treatments from the services that health insurers may reimburse. (German Bundestag 08.07.2026)

Political debate consequently focused on the largest financial questions: how the federal government, pharmaceutical companies, hospitals, physicians and insured patients would contribute to stabilising the system. Medical cannabis remained largely a side issue, partly because the number of patients directly affected is comparatively small.

For those patients, however, the consequences are far from minor. Under German law, patients are only eligible for reimbursed medical cannabis once it has been established that standard treatment options are unavailable, unsuitable or have failed. As Manuel Kralik also described in an earlier Cannabis Briefing interview, applications for reimbursement often follow long and difficult treatment journeys.

What will change?

The reform introduces two main changes.: First, dried cannabis flower will be removed entirely from the statutory health insurance benefit entitlement. It will remain legally prescribable and available through pharmacies, but will generally no longer be reimbursed by statutory health insurers.

Second, access to the cannabis medicines that remain eligible for reimbursement will become more restrictive. These include standardised cannabis extracts and medicines containing dronabinol or nabilone, which are prepared by pharmacies as compounded medicines. (German Bundestag 08.07.2026)

Authorised cannabis-based finished medicinal products already had priority under the existing rules. Before prescribing cannabis flower or extracts, physicians had to assess whether a suitable authorised finished medicine was available. (Federal Joint Committee 16.03.2026)

The new element is a mandatory treatment period. Under the reform, patients receiving statutory outpatient care must first undergo a six-month treatment trial with an authorised cannabis-based finished medicinal product. Only after this trial may the remaining eligible compounded preparations be prescribed at the expense of the GKV.

The prior-authorisation requirement for a patient’s first prescription will remain in place. As before, prescriptions issued by certain specialist groups and physicians with qualifications designated by the Federal Joint Committee will be exempt from this requirement.

How does the law take effect in Germany?

The Bundestag passed the law on 10 July 2026. On the same day, the Bundesrat approved it without requesting any further changes. This completed the parliamentary process. At the editorial deadline, however, the law had not yet been published in the Federal Law Gazette and had therefore not yet entered into force. The following assessment is based on the version adopted by the Bundestag (German Bundesrat 10.07.2026)

According to that text, the changes affecting medical cannabis will not wait until 1 January 2027. Instead, they will enter into force on the day after publication in the Federal Law Gazette. The exact date is therefore not yet known.

Open questions for patients already receiving treatment

The adopted text does not contain an explicit transition period or grandfathering provision.

For patients with an existing approval for reimbursed cannabis flower, this suggests that continued reimbursement may no longer be possible once the new rules enter into force. Prescriptions issued before that date may also become difficult to dispense under the GKV if the pharmacy supplies the medicine only after the law has taken effect. The final reimbursement and billing practice has not yet been conclusively clarified.

It is also unclear how the new six-month treatment trial will be applied to patients who are already receiving cannabis extracts or compounded preparations containing dronabinol or nabilone. As the law does not expressly provide transitional arrangements for these patients either, implementation will depend on how statutory insurers, physicians and pharmacies apply the new rules in practice.

Not back to square one

For the patients affected, the reform is nevertheless a step backwards. One dosage form will be removed from collectively funded healthcare, while access to other cannabis medicines will face an additional hurdle.

At the same time, the treatment infrastructure developed since 2017 will remain in place. Physicians, pharmacies and pharmaceutical wholesalers have built expertise, supply chains and professional standards over the past nine years. These structures provide a foundation for finding workable treatment pathways even under the new reimbursement conditions.

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