For the first time, a higher court has intervened in the dispute over the old health insurance approvals for cannabis flowers. On 21 October 2026, the Sächsische Landessozialgericht (Saxony Higher Social Court) essentially dismissed a health insurer’s appeal against the Dresden interim order (L 1 KR 154/26 B ER). For the time being, the insurer must continue to pay for the supply and bears the costs of both instances.
📑 Inhaltsverzeichnis
Five days ago, we placed the Dresden order in context in our overview of four social courts and two lines of case law, noting there that the insurers could lodge appeals and that clarification by a higher court was still pending. That very appeal has now been decided. We have the orders in front of us.
What the Case Was About
The applicant had received approval from her insurance fund in 2020 under Section 31(6) of the German Social Code (SGB V) in its then-current form. The approval was unlimited and explicitly included dried flower. For years, prescriptions were issued on this basis.
With the GKV Contribution Rate Stabilization Act, cannabis flower was removed from the scope of benefits on July 30, 2026. The insurance fund considered the approval void. However, the Dresden Social Court disagreed and ordered the fund to continue coverage on a provisional basis on September 8, 2026. The fund appealed and additionally issued a revocation notice in September, requesting suspension of enforcement.
The Court’s Reasoning in Two Steps
The first step concerns the approval itself. The State Social Court classified it as an administrative act with lasting effect. A claim granted by a favorable administrative act remains valid under Section 39(2) of the Administrative Procedure Act (SGB X) until it is revoked, such as under Section 48 SGB X due to changed circumstances. The Senate cited a Federal Social Court judgment from January 30, 1997 (4 RA 53/96) in support. According to the decision, the legislative change of July 30, 2026 does not alter this validity.
The second step addresses the revocation notice issued by the insurance fund. The applicant filed a timely objection, which has suspensory effect under Section 86a(1) of the Social Court Code (SGG). The fund relied on the exception in subsection (2) number 3, which applies to the reduction or withdrawal of ongoing benefits. The court rejected this, citing the statutory wording and legislative history: this exception applies only to appeal proceedings, not to objections. As long as no lawsuit has been filed and no immediate enforcement ordered, the matter remains suspended, and benefits must continue under the original approval.
The Procedural Guidance Is Most Practically Useful
For those affected, the most valuable sentence lies not in the outcome, but in the path to it. When an insurance fund indicates it no longer considers itself obligated due to its own revocation notice, the appropriate remedy is not a preliminary injunction, but a judicial determination that the objection has suspensory effect. A preliminary injunction for continued provision only becomes permissible if the fund disregards this determination.
The Senate did not replace the Dresden decision but supplemented it by establishing the suspensory effect. For anyone facing a revocation notice, this means one thing above all: a timely objection is the key. Without it, suspensory effect does not arise.
The Suspension Request Also Failed
Twelve days earlier, on October 9, 2026, the same Senate president had already rejected the insurance fund’s request to suspend enforcement of the Dresden decision. Suspension is only considered in exceptional cases, such as when the appeal has obvious prospects of success. The fact that the insurance fund holds a different legal opinion and cites contrary social court decisions is insufficient.
Notable is the balancing: the financial damage to the insurance pool is reversible because only provisional continued provision is ordered while the approval remains in effect. This decision, too, went against the fund, including costs.
What the Decision Does Not Establish
Four limitations apply, and they are not mere formalities.
- This remains provisional legal protection. No general entitlement to cannabis flower supply can be derived from it, and the main proceedings remain open.
- This concerns a specific approval. It was unlimited and explicitly named flower. Those with differently worded or time-limited decisions do not automatically stand in the same position.
- The conflict is not resolved. The Senate cites in its own reasoning a contrary decision by the Munich Social Court from September 21, 2026 (S 15 KR 1742/26 ER). One State Social Court does not bind other State Social Courts.
- While this decision cannot be appealed further (Section 177 SGG), it only concludes this emergency proceeding, not the dispute over the underlying entitlement.
Our assessment from October 23 remains valid and now carries additional weight. The line of reasoning protecting old approvals has now been confirmed by an appeals court for the first time. The contrary position, which we described in the Leipzig Social Court case, is not resolved but now stands against a higher instance.
Those holding an old approval should review their own decision to verify whether it is time-limited and whether flower is explicitly named. Anyone who has already received a revocation notice should not let the objection deadline expire. Neither of these points substitutes for legal counsel, nor does this article.
Sources: Saxon State Social Court, decisions of October 9 and 21, 2026, L 1 KR 154/26 B ER (certified copies on file with the editorial office); Dresden Social Court, decision of September 8, 2026, S 11 KR 486/26 ER; decisions of the Federal Social Court and other State Social Courts cited in the decision; original reporting. Materials were provided by the affected person under strict conditions of anonymity. Personal details and health information are therefore omitted. This article does not substitute for legal counsel.
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