Cannabis regulation in Germany – opportunities and side effects for Switzerland

/ Aktuelle News / By

Interview with Peter Steger, President of IG MedCan and board member of the Swiss Society for Cannabis in Medicine (SGCM), on the impact of the new regulation of medical cannabis in Germany on the Swiss market.

1. Since August 1, 2022, patients in Switzerland have had access to medicinal cannabis as soon as the treating doctor deems it necessary, without the need for an exceptional permit from the Federal Office of Public Health (FOPH). How has the medical cannabis market developed in Switzerland over the last two years?

This opening of the market was initially linked to the hope that doctors would now be able to issue cannabis narcotic prescriptions more easily. In practice, however, it has become apparent that many doctors are still reluctant to issue such prescriptions. Especially since there are still extraordinary hurdles when prescribing cannabis medicines compared to other prescriptions:

A) the patient wants a therapy (with cannabis medicines) about which the doctor usually has little knowledge.

B) He/she must issue a magistral prescription. A process that is rather unfamiliar to the medical profession and associated with additional uncertainty.

C) The medical profession must keep a record of dispensing in the narcotics register and provide the FOPH with data in each individual case.

D) The medical profession must also take care of reimbursement by the health insurance company, as the patient cannot do this alone.

E) Since cannabis medicinal products are rarely finished medicinal products that the medical profession could sell itself, they also miss out on the opportunity to generate revenue by selling the product after all the effort shown above.

Overall, the medical cannabis market in Switzerland remains in a transitional phase in which the potential has not yet been fully exploited, particularly due to the continued reluctance of the medical profession to prescribe. The continued reluctance of the medical profession, triggered by the reasons outlined above, meant that the abolition of the exemption permit alone had no significant impact on the number of prescriptions in Switzerland. The Swiss domestic market for medicinal cannabis was hardly able to record any significant gains during this phase. Sales remained low and expectations regarding price developments were not fulfilled to the extent hoped for.

2. In Germany, the prescription of medicinal cannabis has been established since 2017. Since April 1, 2024, a narcotics prescription is no longer required in Germany for the prescription of cannabis and medical cannabis will no longer be regulated by the Narcotics Act. Instead, cannabis for medical purposes will fall under the newly created MedCanG. What is your assessment of this new legal classification of cannabis? Has Germany taken on a global leadership role with the new regulation?

Yes and no. Germany has certainly taken on a leading role, but this should not necessarily serve as a model for Switzerland. There are too many unanswered questions. Switzerland can do better. The cultivation clubs and the control of personal possession of cannabis are not clearly regulated and this brings risks on many levels. We are in a transitional phase in Germany. At the moment, this is temporarily helping the medical sector, but this could soon turn 180 degrees. Basically, little has been done in Germany to distinguish the medical market from the recreational market in a meaningful, product-specific way. Only the currently quite high reimbursement rate via the health insurance companies is a positive sign for patients, although this can of course also be exploited by free-time consumers, with a boomerang effect for patients in the end.

Due to the legal reorganization, there are also strange confusions in border traffic at the moment. At the moment, for example, we cannot have hemp seed oil (foodstuffs) analyzed in Germany because this has somehow been linked to the Medical Cannabis Act. The exact reasons are unclear.

3. In a recent decision by the Federal Joint Committee (DE), it was stated that certain groups of doctors can now prescribe cannabis without the need for approval by the health insurance fund. How do you classify this decision?

The circle of doctors who can prescribe without the need for approval has been widened considerably. That is positive. There is also a lot of trust in GPs. It is also astonishing how this was pushed through by the strong opposing lobbies. The German Medical Association and the National Association of Statutory Health Insurance Physicians were against it. You also have to know the German system. Telemedicine practitioners are not panel doctors and therefore cannot simply prescribe on health insurance. However, it is quite astonishing that drugs for which there are no specific clinical studies are so easily reimbursed by the health insurance funds. Although the health insurance company can still refuse in individual cases, even after the G-BA decision, this is still quite a revolutionary step for the medical cannabis industry. Unfortunately, this is hardly conceivable in our health insurance system in Switzerland.

In Germany, however, doctors are generally afraid of recourse claims from health insurance companies (something we fortunately do not have in Switzerland). The recourse system in Germany is a sharp sword. Basic training for doctors on the subject of cannabis would be a good option to give doctors a knowledge advantage, which could take away their fear of recourse.

The Czech Republic has introduced a short special training course for prescribing cannabis and only doctors who have completed the training can prescribe it on the cash register. The reimbursement rate there is over 90 %.

4. Since medical cannabis can be prescribed on a private prescription in Germany, sales have risen significantly. In addition, the prices for medicinal cannabis have fallen sharply in recent years and are on a par with theprices of black market cannabis and in some cases even below. When will medicinal flowers be available in Switzerland for less than 10 francs per gram?

Today, a few thousand patients have a product that they are prescribed. If this changes and there are significantly more prescriptions, the tipping point will quickly be reached where prices fall. The processes of GMP producers are getting better and better and the long supply chains and middlemen are currently having an impact on the high prices. Prices are already falling and will continue to do so.

5. Are Swiss products competitive?

Thanks to our high production standards, innovative strength, growing expertise and strategic location, we are absolutely competitive internationally and will become even more competitive in the future through further optimization.

6. The media report that certain companies are apparently abusing the new liberal regulation and are aggressively marketing medical cannabis. The debate focuses primarily on the telemedical prescription of cannabis and the prescription by e-mail (Süddeutsche / TAZ / n-tv). Is access to medicinal cannabis in Germany too low-threshold?

Telemedicine in the context of prescribing what in Switzerland are called formulary medicines (basically all cannabis medicines except Sativex and Epidyolex fall into this category) is tricky. In general, the tendency to see neither doctor nor pharmacist in person and to start a therapy on this basis is tricky. The fact that large quantities of formulas are being distributed to people in this way disturbs the pharmaceutical industry. They are watching this with suspicious eyes. Normally one can assume that “The Empire strikes back” – such scams have a limited lifespan. It is not necessarily the politicians who will change the laws again if there is too much abuse. The pharmaceutical industry will make its presence felt here and become active with its lobby. So the system should not be overstretched. Unfortunately, I see clear tendencies in this respect in Germany.

In Switzerland, the interaction between the mail order business and telemedicine is fortunately not yet so well established. There are various reasons for this and the SGCM is glad that this is the case. If there is no personal contact between doctor and patient, the prescription of cannabis carries a considerable risk of abuse and the success of the therapy is jeopardized. Any therapy is only as good as the timing of taking the right dose. This recognized scientific fact is all the more important for cannabis therapy.

7. The Finally campaign by Four20 Pharma has made big waves. What do you think about the accusation of hidden drug advertising (see article in the FAZ)?

The radical view is as follows: In Switzerland, there is a fundamental ruling on the subject of migraines and “triptans”, which had deemed a similar approach to be indirect advertising. Product-related advertising for prescription-only preparations is illegal. The campaign is on the borderline here. However, certain statements in the campaign are cleverly chosen and, in my view, work.

8. Do the reputable providers of medicinal cannabis ultimately lose out because they play by the rules?

Yes, from my point of view you can see it that way. On the other hand, the reputable suppliers who have done their milk accounting properly will also have more staying power. From that point of view, you don’t have to be so critical.

9. Licensing for producers was significantly simplified with the introduction of the Medical Cannabis Act. Licenses were granted for “unlimited production”. What opportunities do Swiss producers of medicinal cannabis have on the German market?

It’s difficult to say. My impression is that there are now many growers and producers. So can a Swiss producer compete on the German market due to its quality and reliability? Basically, I think so. Especially if they do their “math” right. Many manufacturers have calculated very optimistically due to the initial boom, and it will be difficult for them. Those who calculate realistically and have the will to persevere will certainly have a chance on the German market.

10. What needs to be improved in Switzerland to ensure that patients have adequate access to cannabis therapy?

The hurdles for doctors described in question 1 must be removed. In addition, a system needs to be considered with the health insurance companies as to how soft factors such as the general well-being and “tolerability” of the patient for their relatives, as well as any reduction in other drugs with side effects and financial relief from the health insurance companies in this respect can be incorporated even more, or how such factors can override the lack of clinical studies. This is one of my main tasks in connection with my work at SGCM and IG MedCann. If we can make it easier for patients to obtain reimbursement, then we will also have the leverage to separate the medical market from a future recreational market and have enough motivating factors to ensure that patients remain under the care of their doctor and obtain suitable quality products from the pharmacy.

Peter Steger is a board member of the Swiss Society for Cannabis in Medicine (SGCM), where he is heavily involved in politics and advocates for the interests of patients and the implementation of standards in the research, production and use of medicinal cannabis. He is also President of IG MedCan, which was founded in 2018 by Swiss manufacturers of cannabis medicines and is committed to a safe and sustainable market for medical cannabis in Switzerland.

Media articles on the topic of medicinal cannabis:

Lukas Brunner
Author: Lukas Brunner