German financial newspaperhttps://app.handelsblatt.com/unternehmen/industrie/aok-tk-und-barmer-immer-mehr-deutsche-patienten-bekommen-cannabis-auf-rezept/23954602.html?ticket=ST-1759639-MqbDqfSehL3oejPpge3N-ap1
Translation:
AOK, TK AND BARMER
More and more German patients get cannabis by prescription
From: Maike Telgheder
The three major health insurance companies received more than 18,000 applications for reimbursement for cannabis as medicine in 2018. Import volumes are also rising significantly.
More and more German patients get cannabis by prescription. AP
Medical cannabis
More and more German patients get cannabis by prescription.
FrankfurtAlways more seriously ill people in Germany get cannabis by prescription. According to a survey of the three large health insurance companies AOK, Techniker Krankenkasse and Barmer, more than 18,400 reimbursement claims were filed last year.
Around two-thirds of these applications, almost 12,500, were approved. In 2017, around 3,800 applications had been approved by the three funds. However, cannabis was only authorized for therapeutic purposes from 10 March 2017 and not from the beginning of the year on. The supply started slowly. Statutory health insurance can submit a request for reimbursement before the start of the treatment, which then checks the medical service of the funds.
The three major health insurance companies AOK, TK and Barmer, with a total of around 45 million members, account for more than 50 percent of the market for statutory health insurance. In total, the three health insurers have approved around 21,300 applications for reimbursement since the release of cannabis as medicine. Overall, the approval rate is around two-thirds, but the figures differ for the individual funds.
In the total of eleven general local health insurance funds (AOK), which received 10,900 applications last year, the approval rate averaged 63 percent. The Techniker health insurance had approved in 2018 of the 2200 applications received about 68 percent, at Barmer, the rate was 71 percent of a total of 5349 applications a little higher.
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The statistics of the health insurance companies show that in the majority of cases especially patients with chronic pain get cannabis on prescription. The cases in which a reimbursement is rejected are often justified by the fact that the patient has other therapeutic options available.
How many patients in Germany get cannabis on prescription is unclear, because there is no nationwide statistic. If one extrapolates the figures of AOK, TK and Barmer, it should now be more than 40,000 patients. Not all are supplied with cannabis flowers.
According to the latest figures from the umbrella association of statutory health insurance (GKV), about 38 percent of the regulations relate to unprocessed cannabis flowers, 34 percent to cannabis-containing preparations such as dronabinol and 29 percent to finished drugs such as the oral spray Sativex or the drug Canemes. These capsules prescribe physicians for nausea and vomiting in chemotherapy regimens. Sativex has been licensed since 2011 among others for the treatment of cramps in multiple sclerosis.
The growing number of patients is creating an increasing demand for cannabis flowers in Germany. That is why importers also increase their import volumes. Since March last year, a total of nine importers at the Federal Institute for Drugs and Medical Devices (BfArM) have applied for an increase in their import volumes to a maximum of 25,600 kilograms. This includes the response of the Federal Ministry of Health to a request by MP Niema Movassat of the Left Party, which is the Handelsblatt.
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Before the release of cannabis as medicine, import permits between 2008 and March 2017 totaled 4,000 kilograms. At that time, only a few patients had a special permit from the Federal Institute for Drugs and Medical Devices (BfArM) to obtain cannabis flowers for therapeutic purposes from the pharmacy.
For cannabis flowers, the BfArM estimates a daily amount per patient of one gram, the annual requirement is then 365 grams per patient. Thus, 10,000 patients would need 3650 kilograms of flowers per year. With the release of cannabis as medicine, the BfArM 2017 had also started a tender procedure for the cultivation of cannabis in Germany. After the first call for tenders had to be abandoned due to procedural errors, 79 bidders or bidding consortia had to submit an offer for the second call. The surcharges are due in the second quarter of this year. The institute expects the first harvest in late 2020.
Niema Movassat, spokesman for the Left Party's drug and constitutional policy, criticizes the BfArM bid for 10.4 tonnes of cannabis flowers spread over four years as a "drop in the bucket". "If Germany wanted to completely replace the import with its own cultivation, 100 tons would have to be tendered," says Movassat.
The federal government must make the tender criteria more practicable, the Bundestag said. It needs flexible quantities and cultivars. This would ensure that the cannabis strains that patients need are grown. The BfArM, on the other hand, points out that when determining the quantity tendered, it had to be taken into account that manufacturers, retailers and pharmacies could continue to buy medical cannabis from importers.