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LSG Darmstadt: health insurance must pay for dronabinol therapy
In the case of a massive life-threatening underweight, the statutory health insurance company may be obliged to pay for cannabis treatment. Even if it has not been proven that no generally recognized medical standard-compliant service is available or cannot be used, there may exceptionally be a claim if the physical integrity is endangered, the Hessian State Social Court (LSG) in Darmstadt decided in Urgent proceedings in a decision announced on Tuesday, July 30, 2019 (file number: L 1 KR 256/19 B ER).
The specific case involved a 19-year-old who has suffered from a rare bowel disease since his early childhood. This goes hand in hand with massive abdominal cramps and loss of appetite. Because of the illness, the young man is massively malnourished. At a height of 1.80 meters, it only weighs 44 kg. His body mass index (BMI) is only 13.6. A BMI between 20 and 25 is normal for men.
The family doctor had initially prescribed the man therapy with dronabinol on a private prescription to improve the pain, appetite and sleep. Dronabinol is the cannabis active ingredient tetrahydrocannabinol (THC).
The health insurance company refused to assume the costs because of the risk of addiction to cannabis if the man already had an addiction.
In its decision of July 18, 2019, however, the LSG temporarily obliged the health insurance fund to pay the insured for one year of dronabinol therapy. In principle, a claim to cannabis treatment can only exist if no other generally recognized service that complies with the medical standard is available or cannot be used.
Although this has not been clarified here, the insured could provisionally receive the dronabinol therapy at the expense of the health insurance because of his right to physical integrity. The man is life-threatening underweight. The attending doctor also stated that the dronabinol treatment that had been carried out on a private prescription for several months had led to a reduction in pain and weight gain. Therefore, a treatment attempt over a longer period of time is appropriate in order to be able to better assess the effect of the therapy, according to the LSG. fle
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Hessian State Social Court, Az .: L 1 KR 256/19 B ER