Israeli Health Ministry Allows Pharmacies, Doctors to Access Cannabis Market

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An employee inspects growing cannabis plants in a greenhouse operated by Breath of Life (B.O.L.), in Kfar Pines, Israel, on September 21, 2016.
An employee inspects growing cannabis plants in a greenhouse operated by Breath of Life (B.O.L.), in Kfar Pines, Israel, on September 21, 2016.Credit: Rina Castelnuovo/Bloomberg

A reform of the medical marijuana market that will allow pharmacies to fill prescriptions for cannabis will take effect on March 31, 2019.

The date was set by the Health Ministry’s medical marijuana department at a meeting last week.

The ministry also plans to add 150 doctors to its list of physicians authorized to prescribe cannabis. This will more than double the size of the list, which currently contains only about 100 doctors.

However, only certain pharmacies will be authorized to fill cannabis prescriptions, most of them belonging to the Super-Pharm chain.

The reform, whose goal is to start treating cannabis like any other medication, will affect more than 30,000 Israelis who use medical marijuana. It will also change the regulations for growing, transporting and distributing the drug.

Today, most of Israel’s medical marijuana is produced by eight companies. Each specializes in specific varieties of marijuana and specific products.

But once the reform takes effect, any company certified by the ministry as meeting its standards will be able to supply cannabis products to pharmacies. The ministry has so far certified three new companies, and others are seeking certification.

Cannabis products will be classified in a uniform manner based on their concentration of the two main active ingredients, THC and CBD, and doctors’ prescriptions – though they won’t officially be called prescriptions, since cannabis still isn’t defined as a medication – will specify the concentration of these materials rather than a particular brand. The ministry hopes this will promote competition among the companies and lower prices.

To obtain cannabis today, most patients must get approval from the ministry’s medical marijuana department. They must then either go to one of the eight companies’ distribution points or pay extra to have it mailed to them.

After the reform takes effect, patients will have two options for obtaining the drug. One is going to a doctor authorized to prescribe it and then taking the prescription to an authorized pharmacy, as with any other drug. Pharmacists will undergo special training so they will be able to instruct patients in its use.

The other is effectively the same process used today: Go to any doctor, even one who isn’t authorized to prescribe the drug, and if he thinks it would help, he will send a recommendation to the ministry’s medical marijuana department, which will then decide whether to authorize the patient to obtain it. But the ministry plans to eliminate most of the red tape this process currently entails and move it completely online (today, the request must be faxed). Thus it shouldn’t be time-consuming for either doctors or patients.

But despite all the promised improvements, medical marijuana users have two concerns that haven’t yet been resolved.

First, patients respond differently to different varieties of marijuana and different cannabis products, in part because aside from the two main active ingredients, the drug contains other active ingredients that vary from product to product. Thus most patients have found their optimal product after considerable experimentation.

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But now that cannabis sold in pharmacies will be classified solely by the concentration of THC and CBD, patients will no longer be able to request a particular variety or a particular product made by one specific company. Thus many patients fear the prescriptions they fill at pharmacies will be less effective, significantly worsening their quality of life.

The second issue is price. Today, patients pay a uniform price of 370 shekels ($100) a month for their cannabis (plus another 100 shekels if they get it mailed to them), regardless of how much they actually use. That price was set in 2009 by agreement with the growers, based on an average of 30 grams per patient.

Under the new, competitive model, there won’t be a uniform price, but the price is widely expected to settle at about 150 shekels for 10 grams. Thus patients who use 20 grams or fewer will pay less, but patients who use large quantities will pay more – in some cases, perhaps even thousands of shekels more.

Deputy Health Minister Yaakov Litzman said recently that if the fears of huge price hikes come true, the ministry will intervene to ensure that patients who need large quantities of cannabis will be able to afford it.

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