The German federal government has answered parliamentary questions from the Greens regarding the priority given to finished cannabis medicines. Two things stand out: there are more approved cannabis finished medicines than have been publicly discussed so far, and the ministry is commenting for the first time on who must actually undergo the six-month therapy trial. However, both points come with a notable caveat.
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Six Approved Preparations, Not Four
In response to a question about which cannabis-containing finished medicines were approved as of the date of the legislative change, the government names six: Epidyolex, Sativex, Exilby, Efysmo, Lyftenzo, and Canemes. In public debate, the first four have dominated discussion. Efysmo and Lyftenzo appear here for the first time in a government response; like Exilby, they come from Munich-based manufacturer Vertanical.
On approved indications, the federal government simply refers to the public medicines information system. It does not directly answer which of the six preparations are suitable for which conditions. This is more than a formality, because this directly determines whether the mandatory therapy trial is medically justified.
The Crucial Sentence—and Its Conditional Language
For patients already well-stabilized on their current therapy, the key passage is this: „Already initiated therapies with other cannabis-containing medicines therefore do not need to be switched to a six-month therapy trial with finished medicines.“ According to the ministry’s assessment, the six-month trial applies only to initial prescriptions.
This sounds reassuring, but it is worded more cautiously than it first appears. The response does not say this is the case, but that it should be the case according to the assessment of the Federal Health Ministry. The reference to the word „initially“ in Section 31(6) of the German Social Code (SGB V) is also in conditional language. Anyone citing this to their health insurance company therefore has a ministerial interpretation—not a binding legal ruling.
There is also a gap: the question this sentence addresses concerned extracts. Whether the same interpretation applies to patients who previously received flowers is unclear from the response. This is precisely where the biggest problem currently lies, because this group has had to be switched since late July anyway.
Where the Response Evades
On the question of whether approved finished medicines are therapeutically interchangeable with each other and with prepared formulations, the federal government does not engage substantively. When asked about scientific evidence for the six-month trial, it responds with a general statement: a medicine that has undergone an approval procedure has a known safety profile and has been tested for quality, efficacy, and safety.
This does not answer the question asked. The question was whether six months on a finished medicine scientifically supports a later decision for an extract—not what approval generally means. On the cost consequences of therapy delays, the response remains general.
We already compiled the questions themselves when they were submitted, which can be found in our article on the 28 questions from the Greens to the federal government.
What This Means for Patients
Those already stabilized on an extract can cite the ministry’s interpretation to their insurance company, but should understand it is an interpretation. Those being switched from flowers are in a worse position: the response says nothing for this case. The fact that courts have so far recognized no protection for existing therapies is shown by a ruling from the Leipzig Social Court. Practically speaking, switching also generates applications whose billing will be restricted from October.
What remains unanswered is precisely what the cannabis industry association has been unsuccessfully asking the ministry for weeks: whether the sentence on protection for existing therapies also applies to flowers. We will continue following this issue.
Note: This article reflects the status as of October 8, 2026, and is not legal or medical advice. The cited statements represent the federal government’s interpretation and are binding on neither health insurance companies nor courts. The choice, continuation, and adjustment of therapy is decided exclusively by the treating physician; ongoing therapies should not be altered independently.
Sources: Federal government response to the written parliamentary question from the Greens, Bundestag document 21/8148 from September 2026, in particular answers to questions 7, 8, 13, and 9; written parliamentary question, Bundestag document 21/7743; Section 31(6) SGB V; newsletter from the cannabis industry association dated September 29, 2026; independent reporting.
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