Medical Cannabis in France: What Comes After the Pilot Programme?

How France Is Preparing for Permanent Access

New rules for the reimbursement of medical cannabis have applied in Germany since 30 July 2026. Cannabis flower is no longer covered by statutory health insurance, including for patients already receiving treatment. Before receiving a new prescription for extracts or other compounded preparations, patients must first undergo a six-month trial with a licensed cannabis-based medicinal product, provided one is available for their condition. Existing treatments with extracts or compounded preparations can continue unchanged. (KBV, 6. August 2026)

France, by contrast, is now working towards moving medical cannabis from a pilot programme into routine care. In March 2021, the country launched a tightly controlled pilot involving around 3,000 patients. Its main purpose was to determine whether a safe and practical medical cannabis supply system could be established. The French medicines agency ANSM gave an overall positive assessment of the programme’s organisation, safety and observed treatment outcomes.

These findings are now intended to inform a permanent system. The legal basis was established through France’s 2024 social security reform. What is still missing is a decree governing the assessment and reimbursement of products. This was submitted to the Conseil d’État for legal review on 2 July 2026.

Under the current timetable, the decree could be published when the autumn parliamentary session begins on 1 October. Whether this schedule will hold remains uncertain. Only after publication can the French health authority HAS complete its reimbursement assessment. Regular prescribing is therefore unlikely to begin before 2027. (Légifrance 26.12.2023, Business of Cannabis 03.07.2026)

Access Will Be Strictly Limited

Like Germany, France is taking a tightly restricted approach to reimbursement. Medical cannabis would only be available when other treatments have failed. Access is planned for five areas:

• refractory neuropathic pain
• certain drug-resistant forms of epilepsy in adults and children
• painful spasticity associated with multiple sclerosis or other central nervous system disorders
• difficult-to-treat symptoms caused by cancer or cancer treatment
• advanced palliative care

Treatment would have to be initiated in a hospital. Prescribing doctors and dispensing pharmacists would also need to complete specific training. Access would therefore be limited to clearly defined patient groups and remain under close medical supervision. (HAS 29.07.2025)

France Is Focusing on Extracts, Not Cannabis Flower

France is also placing tight restrictions on the products that could become available. The focus is on oral and sublingual medicines, particularly standardised cannabis extracts in oil form. The proposed range includes THC-dominant, balanced THC/CBD and CBD-dominant formulations. Cannabis flower of the kind dispensed by German pharmacies would not be allowed. Inhaled products would only be considered in sealed, non-refillable single-dose systems designed for use with a medical vaporiser. From the outset, France is building a market around highly standardised products. Traditional cannabis flower is unlikely to have a place in it.

A Narrow Path That Could Change Europe

France’s plan to give medical cannabis a permanent place in its healthcare system is a positive development. When it comes to reimbursement, the French approach is less different from the German model than it may initially appear. In Germany, access through statutory health insurance is also tightly restricted and subject to specific eligibility rules, including requirements to try other treatments first.

The main difference lies outside statutory reimbursement. Germany also has a private prescription market that is not subject to statutory health insurance rules and where cannabis flower remains available. France is not planning a comparable self-pay market and excludes cannabis flower entirely. The French path therefore remains narrow. But as they say in cannabis care: “Start low, go slow.” New healthcare systems also tend to develop from cautious beginnings that then prove themselves in practice.

Following Germany, France is now the second major EU economy to prepare permanent, reimbursed access to medical cannabis. Other countries will be watching closely to see whether the model succeeds. How broad the French approach eventually becomes will therefore be determined not by the decree itself, but by how it works in practice over the coming years. That will also help determine how quickly the rest of Europe follows.

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