Applications for reimbursement of medical cannabis expenses by Germany’s second-largest health insurer doubled from 2017 to 2019, signaling robust growth in the use of the drug.

Flower remained one of the most prescribed cannabis products, according to data provided in a new release by German insurer Barmer.

Assuming trends witnessed by Barmer are representative of the overall market, the data paints a more complete picture of Germany’s growing medical cannabis sector in lieu of free-flowing data from the country’s federal health regulator.

The fresh information confirm that:

Reimbursement approval rates have remained close to two-thirds since the start of the current program in early 2017.

Significant regional differences exist within Germany, as some states have higher reimbursement approval rates while others have a higher number of applications.

According to Barmer, the health insurer received 14,986 applications for reimbursement between March 2017 and January 2020. Of those, the company approved 10,255, or 68%.

The yearly number of applications Barmer received for reimbursement was:

3,090 between March and December 2017.

5,238 in 2018.

6,094 in 2019.

Marijuana Business Daily estimates that statutory health insurers in Germany reimbursed more than 100 million euros ($110 million) of medical cannabis in 2019.

Barmer’s data also shows that approval rates for patients have failed to improve materially.

Sixty-five percent were approved in 2017, rising to 72% in 2018 before dipping to 67% in 2019.

“Cannabis applications are rejected, for example, if they are to be used for diseases for which other therapy alternatives have not yet been tested,” Dr. Ursula Marschall, head physician at Barmer, said in the news release.

Barmer’s data for German states showed that approval rates ranged from 78% to 56% in Saxony-Anhalt and Hessen, respectively.

Marschall attributes the large regional differences in approval rates to “information deficits and incorrect applications.”

According to Barmer’s data, the largest number of applications was submitted in Bavaria, 3,029, followed by North Rhine-Westphalia’s 2,871 and Baden-Württemberg’s 1,310.

Flower remains one of most popular products, according to Barmer’s data.

Since March 2017, Barmer-insured patients have been prescribed almost 83,000 packages of cannabis products worth approximately 35.3 million euros. About 20,000 of these were packages of unprocessed cannabis flower.

“The demand for cannabis flowers is so high that supply bottlenecks may occur from time to time,” Marschall said.

She also warned that the use of flower is “not without problems,” including “difficulty to dose” and flower products are “more expensive” than other finished drugs.

Germany also experienced supply issues until end of January 2020, though Canadian producer Aurora Cannabis was able to resume sales in February.

A total of 6,714 kilograms (14,802 pounds) of flower was imported into Germany in 2019.

Alfredo Pascual can be reached at [email protected]