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Doctors newspaper online, 10.08.2019
LSG judgment
The Landessozialgericht Hessen requires a health insurance company to temporarily pay a young man for dronabinol therapy.
By Martin Wortmann and Frank Leth
© William Casey / stock.adobe.com
DARMSTADT. In case of a massive life-threatening underweight, the statutory health insurance can be obliged to pay for cannabis treatment.
Even though it has not been established that there is no generally accepted method of treatment available for treatment or that it can not be used in individual cases, a claim for physical integrity may exceptionally be made, the Hessian State Social Court (LSG) in Darmstadt ruled .
The case concerned a 19-year-old who suffers from a rare intestinal disease since his early childhood. This is accompanied by massive abdominal cramps and loss of appetite.
Because of the disease, the young man is severely malnourished. With a height of 1.80 meters, it weighs only 44 kilograms. His body mass index (BMI) is only 13.6. For men, a BMI between 20 and 25 is normal.
The family doctor prescribed a therapy with dronabinol on a private prescription for the man to alleviate the pain, appetite and sleep. Dronabinol is the cannabis drug tetrahydrocannabinol (THC). Because of low income, the man could no longer pay the treatment at his own expense.
First Private Recipe
The health insurance company refused to pay because of the danger of cannabis dependence on man's addiction. In an urgent procedure, however, the LSG now obliged the health fund to pay the insured person the dronabinol therapy for one year.
In principle, a claim to cannabis treatment can only exist if there is no other generally accepted treatment alternative that meets the medical standard or if it can not be used in a specific case. This is still open and can only be clarified in the main proceedings.
Nevertheless, the insured person could provisionally receive the dronabinol therapy at the expense of the cashier because of his right to physical integrity. The man was life-threatening underweight. In an urgent procedure, this must take precedence over the interest of treating it as economically as possible.
Doctor certifies therapy success
The attending physician also stated that dronabinol treatment, which had been on private prescriptions for several months, reduced pain and increased weight.
Therefore, a treatment attempt over a longer period of time would be appropriate to be able to better assess the effect of the therapy, the court said.
Landessozialgericht Darmstadt
Az .: L 1 KR 256/19 B ER
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