Cannabis Telemedicine in Germany: Regulation, Market Entry, Advertising and Enforcement

Written by SKW Schwarz partners Margret Knitter (Head of Medical Cannabis) and Dr Oliver Stöckel (Head of Digital Health).

Digital health is transforming Germany’s medical cannabis market. While technology makes treatment more accessible, the legal framework remains complex, particularly for online platforms, prescribing physicians and companies seeking to reach patients.

Regulation remains a complex legal framework

Patients can now consult physicians, receive prescriptions and access medical cannabis without visiting a physician’s practice. Telemedicine reduces geographical barriers and creates opportunities for digital healthcare providers.

However, regulation for medicinal products, market entry regulations, compliance requirements for advertising and marketing, regulation of provision of pharmaceuticals to patients by mail-order pharmacies and enforcement of the various European and national laws in the respective EU member states remains complex and requires in-depth legal knowledge and advice.

Can medical cannabis be prescribed online by German telemedicine physicians?

Yes, but only subject to certain medical safeguards. Since a reform of German medical professional rules in 2018, German physicians have generally been permitted to treat patients exclusively through telemedicine where medically appropriate in the individual case.

The physician must be able to assess the patient reliably without a physical examination. Video consultations may suffice in some cases; others require an in-person visit.

For medical cannabis prescriptions, physicians must review medical history, symptoms, treatment needs and potential drug interactions and establish a medical justification. If a reliable assessment is impossible remotely, an in-person consultation is required. Telemedicine is therefore an accepted method of treatment, not an exemption from medical standards.

Cross-border telemedicine

According to the decision of 11 September 2025 in the case “Österreichische Zahnärztekammer” (Case C-115/24, DrSmile case), the European Court of Justice (ECJ) clarified that the country-of-origin principle applies for telemedicine services within the European Union. Accordingly, the laws and regulations of the EU member state where the physician is established determine the applicable laws and professional standards.

Following this decision, physicians established and authorised to practise in another EU Member State may, in principle, provide telemedical services to patients in Germany without obtaining an additional German medical licence, subject to applicable EU and national requirements.

Physicians outside the EU cannot generally rely on these rules. Platforms must nevertheless assess the applicable legal requirements in the physician’s home country and in Germany.

Furthermore, platform service providers located in another EU member state may generally offer and perform their services in Germany under the Freedom to Provide Services within the EU. However, national health regulations still have to be adhered to in the EU member states where the services are offered.

For this reason, telemedicine platform operators should not expand their business and enter new markets within the EU without legal advice from lawyers specialised in digital health and medical cannabis law in the respective member state.

What rules apply for advertising and marketing?

Some legal aspects about which laws apply for cross-border advertising and marketing are still being clarified by the courts. For example, it is disputed whether the country-of-origin principle (see the above ECJ decision) only applies to the performance of telemedicine services or also to advertising for such services.

The majority of courts seem to interpret this question rather narrowly and apply the marketplace principle to advertising. This means that the laws of the country in which the services are advertised and whose citizens are addressed by the advertising apply. Once again, platform operators and service providers should thus obtain local counsel to ensure that their advertising complies with the laws of the respective EU member states in which they operate and advertise.

Another legal dispute is currently pending at the ECJ: In the case “Wellster Healthtech Group (Case C-265/26), the German Federal Court of Justice stayed the pending appeal proceedings (decision of 26 March 2026, Case I ZR 118/24) and referred the matter to the ECJ to determine whether the Freedom to Provide Services under Article 56 of the Treaty on the Functioning of the European Union (TFEU) precludes German provisions limiting the advertising for telemedical services. The decision is expected for 2027.

Advertising in Germany: The biggest challenge for telemedicine?

German law distinguishes between providing remote treatment and advertising it. Under Section 9 of the German Healthcare Advertising Act (Heilmittelwerbegesetz, HWG), advertising for remote treatment is generally prohibited unless, according to generally accepted professional standards, personal contact between physician and patient is not necessarily required.

This exception is not assessed on the basis of the opinion of the telemedicine physician in the individual case, but rather generally based on the medical standards in the respective medical field and on the requirements of a proper treatment of a patient with the relevant indications.

In March 2025, the Higher Regional Court of Frankfurt ruled that advertising an initial consultation for medical cannabis treatment digitally via telemedicine violated Section 9 HWG. However, the court considered advertising digital follow-up consultations permissible where the advertised treatment model included an initial in-person consultation and subsequent remote consultations were offered only where medically appropriate (Higher Regional Court of Frankfurt, judgement of 6 March 2025, Case 6 U 74/24).

The German Federal Court of Justice held that advertising treatment for erectile dysfunction based solely on online questionnaires violates Section 9 HWG when assessed against generally accepted medical standards in Germany (decision of 26 March 2026, Case I ZR 118/24). Although the case did not concern medical cannabis, it illustrates the importance of medical standards for advertising telemedicine services.

The precise scope of advertising claims matters as well. Broad promises of convenient online prescriptions may create substantial legal risks. Moreover, the courts in Germany are traditionally quite strict in all matters of healthcare-related advertising.

Prescription drugs cannot be advertised to consumers

Section 10 HWG generally prohibits advertising of prescription-only medicinal products to the general public, including medical cannabis. While prescriptions of medical cannabis via telemedicine are possible, advertising medical cannabis vis-à-vis non-healthcare professionals is illegal in Germany. 

In a recent landmark decision, the German Federal Court of Justice ruled that a telemedicine platform violated this prohibition by promoting medical cannabis as a treatment for certain conditions while enabling patients to request consultations with cooperating physicians. Importantly, the Court clarified that advertising may be unlawful even without mentioning specific cannabis products or manufacturers (judgement of 26 March 2026, Case I ZR 74/25).

Neutral, objective, non-promotional information about medical conditions and treatment options may be permissible. However, the overall presentation must not be designed to encourage patients to seek prescriptions for medical cannabis or to retain the services of the platform. A strict demarcation between medical information and promotion is required.

Which types of cooperations with physicians and pharmacies are possible?

Digital platforms may connect patients with physicians and pharmacies but must respect physicians’ professional independence. Physicians remain responsible for diagnosis and prescriptions. Platforms must not improperly influence medical decisions or restrict patients’ freedom to choose physicians. Patient-referral fees or commissions calculated as a percentage of physicians’ fees may violate professional and competition law requirements.

While it is generally possible and legal for platforms to cooperate with partner pharmacies to provide prescribed medication to patients via mail-order services (also cross-border within the EU), the patients’ right to choose the pharmacy should also be respected. Again, referral fees or commissions to be paid by the pharmacy for forwarding patient prescriptions are often non-compliant with the laws in the respective member states.

Proposed Changes to Germany’s Medical Cannabis Act

In October 2025, the German government approved a draft bill to amend the Medical Cannabis Act (MedCanG). It would require an initial in-person consultation before prescribing medical cannabis flowers and at least one further in-person consultation annually.

Mail-order dispensing of cannabis flowers would also be prohibited, although pharmacy delivery services would remain possible. These measures could significantly disrupt platforms relying on fully remote consultations and online pharmacy deliveries. The amendments have not yet been adopted, and whether they will become law remains yet uncertain (German Bundestag, BT-Drs. 21/3061).

How attractive is the German market for the medical cannabis industry?

Germany still offers many opportunities for medical cannabis telemedicine platforms, but businesses must ensure medically sound treatment models, independent prescribing decisions, respect the patients’ right to choose physicians and pharmacies, and adapt their advertising and marketing strategies to national laws and regulations. Specialised legal consultancy before expansion and market entry in Germany is vital. Cross-border operations and pharmacy partnerships require particular scrutiny.

The central challenge is balancing patient protection and access to care with innovation in digital healthcare. How Germany resolves that tension will shape the future of its medical cannabis market.