Author: Marguerite Arnold

According to Barmer, one of the largest statutory health insurers in Germany, the great “cannabis hype” is over – but is this really the truth?

If you are the CEO of Barmer, one of the largest German health insurers, it is easy to look at numbers and be copacetic about the cannabis status quo. Indeed, CEO Christoph Straub has made the headlines in Germany of late, proclaiming that the “big hype about cannabis seems to be over.”

Straub attributes the drop in applications to a “more targeted use.”

But is this really true?

Even five years ago, about 40% of applications were being summarily denied. The fastest way to get such approvals was, certainly for this population of patients, to sue their insurers.

The reality is that the insurers are not really on the front lines of approvals. The MDK, a state-by-state entity is actually still the last word on approvals. And they are still singing the same old tune.

The MDK is Ignoring the Latest Medical Studies

Patients who have had to struggle to first find doctors and then submit their applications through the system have a different perspective than a self-satisfied (non-sick) corporate executive.

Even when they have multiple doctors writing letters for their approvals, the MDK is more intent on turning down patients than approving them, and in particular, citing studies that are often outdated.

They are insulated by the insurance companies, who are themselves pointing fingers at the MDK.

Straub himself told Deutsche Apotheke, one of the larger professional zines in Germany that “further studies will be needed to better understand the complex mechanisms of action of cannabis and to integrate them into individual treatment concepts.”

However, as many patients will attest, even when they or their doctors include cutting-edge studies in their applications, these are ignored by the MDK committees of “experts” who have little interest in changing the way severely ill patients are treated, and even more certainly, with cannabis.

A Catch 22

Patients right now are caught in a terrible trap. They can decide to sidestep the process of approvals altogether and just go to a private doctor. However, this, along with the cost of prescriptions, makes this option completely unappealing if not financially feasible. What it does prove, however, is that the MDK has a different standard for treating the seriously ill than frontline doctors.

Beyond this, patients often still have to turn to the black market – and this obviously is dangerous and almost as expensive. Growing your own remains highly hazardous.

Regardless, it is clear that health insurers and the MDKs beyond this have managed to essentially stop the medical cannabis revolution in its tracks. The only way for the industry to grow and patients to gain at least legal protection that comes with decriminalization is through full and final reform.

What is the model for recreational distribution likely to be in Germany?

Last fall, the new Traffic Light Coalition promised to enact recreational cannabis reform in Germany. However, beyond the actual schedule of reform, which has now been informally delayed until at least next year and 2024, there are already debates and discussions about what that reform might look like. 

This starts with what kind of regulated outlet cannabis can be sold at.

There has been some discussion of following the Swiss model – namely to start by dispensation via pharmacies. This of course would make sense as pharmacies are already in the business of cannabis dispensation. Further, a working model right across the Swiss border could be applied directly to the industry.

This idea however so far has not been uniformly embraced as many in the industry see their futures as running cannabis “dispensaries” more akin to the US or Canadian model. This would require stores to be separately licensed. The process of setting up such a system would inevitably take much longer and be fraught with the same issues that have arisen in North America. Namely, how would such licenses be dispensed and who would be eligible to receive them.

A Dispensary Rush?

In the United States, the process of obtaining dispensaries in many states was introduced by lottery. This benefitted those with money and political connections and largely left out everyone else. 

Beyond this, there is also the issue of where such dispensaries or stores would be located, if states and municipalities refuse to allow the same, this could also lead to additional problems for the industry, akin to what has already occurred in every single legalizing jurisdiction in North America and Holland so far.

What Does the Industry Want?

The further problem the looming legal dispensation of cannabis will create splits in the industry itself. There is no consensus from the medical cannabis pharmacies about whether they want to sell adult-use cannabis. 

Beyond this, being Germany, the entire discussion of which regs will apply (and to whom) looms large. This is particularly true given the police habit, so far, of indiscriminately invading premises and penalizing both companies and individuals under the German Narcotics Act.

The bottom line, no matter when the legislation for adult use comes, is that there is going to be another big fight looming, this time within the industry, particularly for those who have also established “CBD stores.” Complicated of course, by continued police intransigence to cannabis reform itself.

Be sure to book your tickets now for the upcoming International Cannabis Business Conference events in Berlin and Zurich!