About a month before international cannabis company Tilray announced that it was shipping from Portugal to Germany, Sativex (manufactured by the British-based GW Pharma) was approved for use by the Portuguese government. This means that the actual cost of the drug, deemed too expensive by the NHS in the UK, will be partially underwritten by the Portuguese government.

Portuguese patients with MS will now face expenses of about $350 per spray bottle. To put this into real patient (if not grey market) terms, that’s about the cost of an ounce in the U.S. and about half the cost of the same amount in the unregulated market across Europe.

Most patients use more than 1-2 spray bottles of Sativex per month.

With Tilray now exporting to Germany, this poses an interesting question. Why was the Portuguese government subsidizing a British company to import cannabinoid-based drugs right before a Canadian company with domestic production announces that its latest crop is slated for export? Especially as Tilray’s campus is capable of producing products at a high enough standard to be accepted by the German government?

Why didn’t the Portuguese government just buy the product locally?

Part of the answer lies in what was just approved. The Portuguese government, for all of its supposed freewheeling drug policy, is unwilling to admit that medical cannabis works on MS or any other condition, in any other form than a pharmaceutical spray. And furthermore, that non-pharmaceutical spray also works for MS patients, sometimes better than their own branded entry.

Tilray’s product, in other words, grown in Portugal, is not on the docket to be reimbursed by the government on the consumption side. So the company looked for a market where it would be. This is no different than what has happened in Holland since early 2017.

Part of this conundrum is also caused by the fact that cannabis companies are desperately trying to find justification for pharmacizing their products. This is inevitable in a world where “strains,” the great hope of breeders if not the larger companies everywhere, are bound for obscurity, especially in Europe.

While this creates a better justification on corporate bottom lines, what it is also doing is driving local production out or setting a bar too high for most to participate, just as there is a local population to supply. It is also increasing the overall costs of cannabinoid medical access to European governments – both in the home and exporting countries.

Companies Are Seeking Higher Market Returns

Because of this, patients are still faced with the unappetizing process of applying for the drug through a regional health service and finding that it is still usually cheaper and more accessible to skip the pain and go back to the unregulated market.

In turn, this also has a political effect. With legislatures across the continent wrestling with greater medical access and cost issues as well as the option of just ditching the entire debate and pushing patients into a recreational space (see Holland), the concept of cannabis as a reimbursable drug becomes laden with an additional layer of socioeconomic angst attached to all discussions over healthcare in the room right now.

The bottom line? 2019 might well be the year in which the tide turns and European governments, recognizing that cannabinoids are not going away, will push for more domestic production and sovereign ownership. Especially now, with the recreational discussion on the table thanks to Luxembourg.

What that means for medical reimbursement, however, if not cost control beyond that is still unclear, and that will likely be the case for several years to come.

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