The Czech Republic was one of the first countries in Europe to allow the use of cannabis for medical purposes. This was achieved in 2013 by means of an amendment to the Act on Pharmaceuticals, which was subsequently implemented by the “Cannabis Regulation.” Despite this, access to medical cannabis still remains difficult for many patients.
Prescribing Medical Cannabis
Qualitative requirements: The term “medical cannabis” refers to the dried female flowers of the plant Cannabis sativa L. or Cannabis indica L., with levels of THC (tetrahydrocannabinol) and CBD (cannabidiol) within the ranges set out in the Cannabis Regulation. The ranges are wide – from 0.3 percent to 21.0 percent for THC and from 0.1 percent to 19.0 percent for CBD.
Indications: Medical cannabis is used as an auxiliary treatment to alleviate symptoms accompanying serious illnesses. Medical cannabis can only be prescribed by doctors with the appropriate specialization and only for the health indications listed in the Cannabis Regulation. For example, specialists in neurology and geriatrics are allowed to prescribe medical cannabis for a wide range of health conditions, including spasticity and pain associated with multiple sclerosis. In order to make information on prescribing doctors and their specializations accessible to patients, the State Agency for Medical Cannabis publishes a list of doctors on its website.
Quantity Limit: The total amount of medical cannabis that can be prescribed to a patient was originally limited to 30 grams per month. This was increased to 180 grams per month. Medical cannabis can only be prescribed by means of an electronic prescription system, known as the “register of restricted medical products,” which can be accessed by doctors and pharmacists. Pharmacists dispensing medical cannabis must check whether or not the patient has already reached the monthly limit.
Although growing and possessing cannabis is generally forbidden, possessing medical cannabis under prescription is an exception. The police have the right to demand the patient’s ID card and to check the register to verify the amount of medical cannabis already dispensed to the patient. Possessing more than the prescribed limit could be considered a minor offence or a more serious crime, depending on the amount.
Barriers to Access
For the first two years after passage of the medical cannabis law, patients were blocked from obtaining cannabis because there was no electronic register of restricted medical products; it only became operational in 2015. Then, due to difficulties in the public tendering process for suppliers of cannabis to the Czech market, there was a shortfall of cannabis in pharmacies. Currently, price remains the major barrier to patients wanting access to medical cannabis.
Generally, public health insurance does not cover prescriptions of medical cannabis. The law provides for an exceptional reimbursement in special situations, where the medical product in question is the only suitable treatment for the patient’s condition. Considering these stringent conditions, it comes as no surprise that insurance companies are strongly opposed to reimbursing the cost of medical cannabis. In one noteworthy case, after considerable media coverage and repeated litigation, including a complaint to the Constitutional Court, the General Health Insurance Company (the largest, state-owned insurer) agreed to pay the cost of the medical cannabis prescribed to the patient, who suffered from multiple sclerosis.
Proposed Changes to Reimbursement
A bill introducing insurance coverage of medical cannabis is currently under debate in Parliament. According to the bill, insurance would cover 90 percent of the price of up to 30 grams of medical cannabis per month. If approved by the insurance company’s doctor, this could be increased to 180 grams per month (i.e., the total quantity limit). This approval requirement may represent a barrier to access for patients with severe conditions who need larger amounts of cannabis.
The bill also introduces a new duty on doctors prescribing cannabis, requiring them to inform the regulator about the method and results of treatment for each patient receiving a prescription. This duty could be burdensome for doctors and may potentially discourage them from prescribing it.
Even though prescription of medical cannabis has been permitted for the past six years, the number of patients using it remains low. Currently, this can primarily be attributed to the high price of medical cannabis and lack of insurance coverage, which particularly affects patients with severe conditions needing larger amounts of cannabis. Even if passed, the new bill introducing insurance reimbursement of medical cannabis will not remove the barrier for such patients.
By Monika Maskova, Partner, and Michal Rehorek, Associate, PRK Partners
This Article was originally published in Issue 6.6 of the CEE Legal Matters Magazine. If you would like to receive a hard copy of the magazine, you can subscribe here.