New rules for medical cannabis in Israel

New steps outlined by the Health Ministry will make it easier for consumers of medical cannabis to access their medications, according to a ministry statement on Thursday.

“We are attentive to criticism and to improving in order to ease the suffering of patients,” Deputy Health Minister Ya’acov Litzman said. “We will continue to promote further activities on the matter.”

Part of the ministry’s plan is to supervise the pricing of cannabis to keep it under control. The supervision will take place under the authority and approval of a price committee, which will consist of representatives from the ministries of finance and economy.

“A large proportion of the patients will pay less than what they currently pay in the old system,” the ministry wrote in a statement. A fixed payment for pediatric patients and oncology patients will be set at around NIS 500, which will cover their cannabis medications regardless of the amount that they use.

The ministry also hopes to establish a maximum price for public doctor visits, which take place for the purpose of attaining a license to use medical cannabis, to between NIS 279 and 283. This change is subject to approval of the ministries of finance and economy.
Although the ministry released new guidelines regarding licensing in April, it announced that patients holding old licenses would still be able to benefit from the new system. Until January 2020, pediatric patients and patients with autism will be able to choose whether to follow the old system or the new one.

Under the new system, “prescription splits” will be allowed, meaning that patients will be able to purchase part of their prescription at one pharmacy and part at another.

Harry Rubinstein, who has used cannabis in the past to treat his chronic pain from Ankylosing spondylitis, is skeptical that the new system will actually make it easier for patients to access medical cannabis.

He said that limiting the prices of visits to public hospitals was redundant, as those visits already had a price cap. It is the private doctors, he said, who charge exorbitant amounts. When Rubinstein first met with his doctor, he faced fees of around NIS 2,000.
Rubinstein also didn’t think that it was right for medical cannabis to be sold on the market without some sort of government subsidy.

“As far as I see it, they have to classify medical cannabis as medication, and it needs to be in what they call ‘the health basket,’ meaning that it’s subsidized by the Ministry of Health like every other medication,” he said. His monthly expenses usually reach around NIS 700.
To Rubinstein, it seemed like the Health Ministry’s policy was targeting less essential areas, rather than focusing on what matters most: increasing access to medical cannabis and ensuring that the quality is up to par.

In a report that Rubinstein compiled about BOL Pharma, a cannabis supplier, he stated that 50 patients complained that their bags of cannabis had been “contaminated with mold.” He said that the flowers that patients have been ordering “arrive extremely dry with a smell akin to grass clippings.”

When he heard about the new rules regarding pharmacy splitting, Rubinstein said that the underlying issue which is not being addressed is that the supply of cannabis is so limited that patients have no choice but to search for their medications at a number of different pharmacies.

“The issue right now is not splitting, there’s nothing anywhere,” he said. He said that patients “go to one pharmacy, they don’t have it, they call another pharmacy, by the time they get there it’s out. There’s an extreme shortage right now in Israel. That’s the issue. So yes, it’s a great initiative, they’re going to do that, wonderful, but there’s more pressing things.”

Shay Arad, a business adviser for medical cannabis companies, said that it was very important for the Health Ministry to listen to what the patients and users of medical cannabis have to say.

“With all the pain of the patients, the authorities must listen to them,” he said.

He said that the process of changing the medical cannabis system was one that should be a steady one, which moves in steps, rather than large leaps at a time. “We’re talking about a complicated process,” he said. He said that he expected the ministry to continue to adapt the rules, as they record the effects of each change.

“We will go by step, doing changes, getting feedback from the patients,” he said. “It’s very important.