It is a major chore. Regulators need to deal with this issue more urgently than “recreational reform”

Yesterday was a red letter day. I got the message, via my attorney, even on a German national holiday, that my German health insurer had finally approved my medical cannabis coverage.

It has “only” taken two and a half years of battling with them, numerous doctor visits to try to find the right doctor, one of which was so hostile to the idea of medical cannabis generally that she (highly illegally) tried to bill my sessions to my health insurer (without my knowledge) with her as “cannabis drug addiction treatment.”

I have fought major battles in my life, not the least of which has been to become “German.” That took a Supreme Court case (2BvR 2628/18) and seven years of my life.

The next battle was the battle for not only German public healthcare coverage (which required sadly both German citizenship despite an Executive MBA and being here, on the ground), but getting medical cannabis coverage.

To set the scene, I have Dystonia, a rare and serious neurological condition which is notoriously treatment resistant at the best of times. The “traditional” treatments, including painful shots with Botox (a poison, which paralyzes and kills nerves), do not work with me. I am violently allergic to them.

However in the current German healthcare regime, despite its general superiority over say, American and British systems, people like me are in an odd boat to begin with. Add in unfamiliarity with the language, not to mention all of the other logistical hurdles that I have faced, and we too often fall through the cracks. If not worse.

How Did I Do It?

Here are a few suggestions for those who are still in a boat that is painful, awful, takes too long, and is far too overly bureaucratic.

1. Find a sympathetic doctor. A specialist is better. When you go to this doctor, bring all relevant medical notes. The doctor will need to fill out information about your condition, why you need cannabis (namely that there is no other alternative), and hopefully cite the 2017 law in his or her recommendation. This puts the insurance company and the insurer on notice that you know about the law, and are prepared to fight for your rights. It also helps should you get busted along the way to approval (as happened to me), and you end up in criminal court. More on that below.
2. Make sure that, per the 2017 law and the most recent nasty case precident (an ADHD case), that your doctors note that you have a certain kind of condition (or comorbidities), and explain why medical cannabis treatment is the only treatment that will work. It helps if you have a movement disorder, and or suffer from chronic pain and continual muscle spasms.
3. Prepare to wait. And wait. The supposed timelines and deadlines, even the revised ones, means that you can expect to wait up to three months for the first refusal. This will normally come from the MDK, the regional health body that evaluates requests like this, and to whom the insurer, no matter who they are, sends your cannabis request. The insurer will follow the guidelines of the MDK.
4. In my case, even with all of the proper documentation, the MDK turned me down, again, in the spring of 2023, for the same stupid reasons as they had the last time. It wasn’t like I was getting better, but they put a great deal of information in my refusal about how cannabis was still an experimental drug, and that I should, again, submit myself to horrible treatments that make me worse, not better.
5. Be prepared to protest loudly, in writing, multiple times. At one point, my health insurer actually refused to move forward because I had not submitted a signed original letter, in German.
6. Be prepared to have to go to a private doctor to get your initial prescriptions. Then you have a record at least of being a legitimate patient. There are more and more private clinics who do this, but for a significant fee up front. Then you have to pay for the cannabis.
7. Be prepared to get a lawyer. And have them immediately request your records from the insurance company. Sometimes this may trigger an approval (as it suddenly did in my case). Going to court, particularly further pending change in the law, is expensive for health insurers, and they are increasingly going to lose.
8. Be as ornery and cranky as you need to be. You are sick. You have rights. You are required to pay for healthcare coverage. Your insurer is required to respond when you can prove you are sick.

What The Bundestag Needs To Know

The current system is unwieldy. The people who are being harmed the most by the continued status quo are patients. These are people who have no other choice but to be caught up in a system which is still too unwieldy and bureaucratic.

Legalization needs to happen, and now. It can’t keep happening at the margins.

Too many people are being hurt by this. And I can’t even begin to calculate the bureaucratic costs of the status quo.