The current draft bill to amend the Medical Cannabis Act (MedCanG) is stirring debate: in the future, prescriptions for medical cannabis may only be possible following an in-person consultation with a physician. In addition, online mail-order sales through pharmacies are to be prohibited. This article outlines what is planned and the potential implications.
What is new?
The rapid developments in the German medical cannabis market have prompted the legislator to initiate amendments to the existing Medical Cannabis Act (MedCanG). The declared aim of the law is to ensure comprehensive health protection – both for individuals who medically rely on cannabis and for those outside this group.
A major driver of the proposed changes appears to be online platforms that offer a new model for the provision of medical cannabis. These models typically work as follows: interested individuals complete an online medical questionnaire, which is reviewed by a physician. Based on this, the physician – in some cases located abroad – either issues a prescription or refers the patient to local practices. Prescriptions can then usually be redeemed online or at a local pharmacy. These services are generally self-paid, meaning the patient covers both the medical consultation and the cannabis on the basis of a private prescription.
The practice of issuing prescriptions without an in-person consultation between physician and patient, and redeeming prescriptions issued in this manner, has faced criticism – in particular from pharmacists’ associations and medical chambers. The legislator has incorporated this criticism into the draft bill, which introduces among others the following significant changes:
- Obligation of in-person consultation between physician and patient at the time of the initial prescription of medical cannabis and for subsequent prescriptions at least once every four quarters;
- Prohibition of distributing medical cannabis flowers through mail-order trade.
Current legal framework
Since 1 April 2025, medical cannabis has been removed from the list of narcotics in Germany. Since the Medical Cannabis Act (MedCanG) stepped into force, medical cannabis is classified as a prescription-only medicinal product.
Since then, imports have risen sharply, and a significant online market for medical cannabis has emerged. Various start-ups have established themselves by facilitating easy access to prescriptions and supply of medical cannabis through digital platforms. The current draft bill is a direct response to these developments.
Obligation of in-person consultations
If enacted in its current form, the law would - as described above – require in-person contact between physician and patient when prescribing medical cannabis for the first time. Follow-up prescriptions could be issued after an in-person visit at the same practice, a home visit, or a telemedical consultation. However, at least one in-person consultation at the practice would be required within each four-quarter period.
Follow-up prescriptions would not need to be issued by the same physician, but by the same practice where the initial in-person consultation took place. According to the legislative reasoning, this includes group practices or medical care centers (MVZ). Thus, medical cannabis could continue to be prescribed by any other qualified physician within such institutions – including across locations – provided access to the patient’s local records and communication with the initial prescribing physician is ensured. This interpretation is supported by the legislative purpose: what matters is that the patient is “known,” which is guaranteed through access to records as well as the possibility of consulting with the “initial prescriber” within the institution.
Prohibition of mail-order sales
Another key change is the prohibition of mail-order sales of medical cannabis. According to the current draft, violations are subject to criminal sanctions, including fines or imprisonment. Pharmacies would therefore be required to remove cannabis from their online offerings for medicinal products. This article does not address issues of pharmaceutical advertising law related to the presentation of such products.
Implications of the recent CJEU ruling on cross-border telemedicine
The draft bill also gains relevance in light of a recent CJEU decision (C-115/24) on fundamental issues of cross-border telemedicine. The ECJ held that, in principle, the applicable law for cross-border treatments is that of the country where the healthcare provider is established – not where the patient resides. Applied to the MedCanG draft, this raises questions such as: May physicians abroad, who are permitted under their national law to prescribe medical cannabis without an in-person consultation, continue to do so for patients residing in Germany – while German physicians would be prohibited from doing so? Would German pharmacies be obliged or permitted to dispense such prescriptions? And how could such models be advertised lawfully?
Conclusion
The combination of the draft bill and the recent CJEU ruling illustrates how complex and dynamic the regulatory environment currently is. Many questions remain unanswered – from the practical handling of telemedical prescriptions to jurisdictional issues and advertising rules. Both the draft bill and public statements by Federal Minister of Health Nina Warken and the Federal Government’s Commissioner on Narcotic Drugs, Hendrik Streeck, suggest that the new federal government may pursue a less liberal cannabis policy. Whether this will lead to a policy shift, what such a shift may look like, and whether it will also extend to medical cannabis remains unclear. The Federal Ministry of Health has pointed to the ongoing evaluation of the current law. Companies and service providers are therefore well advised to closely monitor developments and carefully assess their legal options.
The restrictions on prescriptions and mail-order sales of medical cannabis foreseen in the draft bill would have significant effects on patient care – particularly in rural areas with limited physician and pharmacy density. Companies specializing in telemedicine-based cannabis care would face substantial consequences, requiring a restructuring of their business models. Mail-order pharmacies would also face severe limitations on their online offerings and sales. Critics argue that these restrictions could strengthen the black market for cannabis, where product quality is not subject to controls.
It remains to be seen whether the planned drastic changes will indeed be implemented or whether a more measured approach will be taken to ensure safe and high-quality care for patients dependent on medical cannabis.
Outlook
The draft bill represents the first written version of the law before the start of the parliamentary process. It is scheduled to be discussed in the cabinet meeting on 8 October 2025. This will be followed by hearings, consultations, and the cabinet decision, before Bundestag and Bundesrat open the legislative procedure. On average, this process takes four to seven months and, if approved, leads to enactment of the law. Further amendments are therefore likely; the exact date of entry into force is not yet foreseeable.
Companies that have so far benefited from the current legal framework should prepare for possible changes and seek legal review of whether, and in what form, legal action against the law might be advisable.
