Does Australian Health Insurance Cover Medicinal Cannabis and CBD Oil?

Last updated: June 2026

This guide is for Australian patients who hold private health insurance and want to know whether their fund will contribute toward the cost of medicinal cannabis or CBD oil. The short answer is: most Australian private health funds do not cover medicinal cannabis as a standard benefit, because the Pharmaceutical Benefits Scheme (PBS) does not yet list most cannabis medicines. However, a small number of funds offer limited extras cover under natural therapies or compounding provisions, and the coverage landscape is changing. What follows explains exactly where things stand, which funds to ask, and what questions to put to your insurer before you pay out of pocket.

Why Is Medicinal Cannabis Generally Not Covered by Health Insurance?

Private health insurance in Australia is regulated by the Private Health Insurance Act 2007 (Cth) and the Australian Prudential Regulation Authority (APRA). Benefits for pharmaceutical products are tightly linked to PBS listing or Therapeutic Goods Administration (TGA) registration. The vast majority of medicinal cannabis products are prescribed through the TGA's Special Access Scheme (SAS) or the Authorised Prescriber (AP) pathway, which means they are approved for individual patients but not formally listed on the PBS.

Because PBS listing drives most pharmaceutical rebates — both under Medicare and under health fund hospital formularies — the absence of PBS listing is the primary reason most funds decline to cover cannabis medicines. Until products move onto the PBS, patients typically bear the full cost unless their individual fund has made a discretionary policy exception.

One product, low-dose cannabidiol (nabiximols, brand name Sativex), has TGA registration, but it is not PBS-listed at the time of writing. TGA registration alone does not trigger private health fund coverage.

Which Private Health Funds Offer Any Coverage in 2026?

Fund policies change regularly. The funds below have either confirmed limited benefits or have published relevant policy language as of early 2026. Contact your fund directly to confirm current terms before you claim.

Note: This table reflects publicly available policy information and member communications current to June 2026. Fund policies can change without notice. This is not financial advice.

What Does "Extras Cover" Actually Mean for Cannabis Patients?

Extras (or "ancillary") cover is the part of a private health policy that pays partial rebates for services and products outside hospital admissions — think dental, optical, and physiotherapy. A handful of funds have chosen to treat certain compounded cannabis preparations under natural therapy or compounding medicine benefit categories within extras.

To access an extras rebate for medicinal cannabis, patients typically need:

• An active extras policy that explicitly lists compounding pharmacy or cannabis as a covered category
• A valid prescription from a medical practitioner holding AP status, or a product dispensed under TGA SAS Category B approval
• A receipt from an authorised compounding or dispensing pharmacy showing the product name, quantity, and cost
• A claim lodged within the fund's standard time limit (usually 2 years from the date of service)

Hospital cover policies almost never contribute to medicinal cannabis costs, because the medicines are not on an approved hospital formulary. If you are admitted to hospital and use medicinal cannabis as part of your treatment, assume you will pay for it separately unless your treating team and fund confirm otherwise in writing.

How to Check Whether Your Fund Covers Medicinal Cannabis

The most reliable approach is to contact your health fund's member services team directly. Before you call or write, have the following information ready:

• The exact product name and TGA approval pathway (SAS-B or AP)
• The dispensing pharmacy's details (compounding or standard)
• The ICD-10 or clinical indication your prescriber has documented
• Your current policy number and extras tier

Ask the fund to confirm any benefit in writing before you fill the prescription. Verbal assurances may not bind the fund at the claims stage.

You can also use the government's privatehealth.gov.au comparison tool to review your current policy's benefit schedule, though cannabis-specific line items may not be clearly labelled.

Does Medicare Cover Medicinal Cannabis?

Medicare does not currently reimburse patients for the cost of medicinal cannabis products. The Medicare Benefits Schedule (MBS) covers consultation fees with your prescribing doctor under standard GP or specialist item numbers, but the medicine itself attracts no Medicare subsidy unless it achieves PBS listing.

A PBS listing application for certain cannabis medicines has been discussed in policy circles, but no cannabis product appeared on the PBS Schedule at the time this guide was published. Patients and carers are encouraged to monitor the PBS website for updates.

Recent Regulatory Changes Affecting Coverage (2024–2026)

Several developments since 2024 are relevant to coverage prospects:

• TGA rescheduling (2024): Low-dose CBD (up to 150 mg per day) was moved to Schedule 3 (pharmacist-only), allowing over-the-counter access for adults for certain indications. Schedule 3 products are generally not claimable through health insurance extras because they do not require a prescription, but they are more accessible and lower in cost than prescription alternatives.
• PBS review process: The Pharmaceutical Benefits Advisory Committee (PBAC) has received submissions for certain cannabis-derived medicines. A positive PBAC recommendation would be the most significant change to coverage eligibility, as PBS listing would require health funds to include the medicine in hospital formularies.
• Private Health Insurance (Benefit Requirements) Rules: Updated rules from the Department of Health and Aged Care continue to govern which services attract minimum default benefits. Cannabis medicines have not been added to default hospital benefit categories.

Reducing Out-of-Pocket Costs Without Insurance

If your fund does not cover medicinal cannabis, there are other avenues worth exploring with your prescribing clinician:

• Compassionate access programs: Some manufacturers offer patient assistance schemes for people experiencing financial hardship. Ask your prescriber or pharmacist.
• Clinical trials: Participating in a registered clinical trial may provide access to medicinal cannabis at no cost. Search the Australian New Zealand Clinical Trials Registry (ANZCTR) for open studies.
• Switching to Schedule 3 CBD: If your clinician considers it clinically appropriate, lower-dose Schedule 3 CBD products available over the counter are considerably cheaper than prescription formulations.
• Tax deductibility: Out-of-pocket medical expenses may be relevant to your tax position. Speak with a registered tax agent.

Frequently Asked Questions

Can I claim medicinal cannabis on my health insurance if I have hospital cover?

In almost all cases, no. Hospital policies pay benefits for medicines on an approved formulary, which relies on PBS listing. Because most cannabis medicines are not PBS-listed, hospital cover does not apply. Always confirm with your fund before an admission if cannabis forms part of your treatment plan.

Is CBD oil treated differently to other cannabis medicines for insurance purposes?

Low-dose CBD products rescheduled to Schedule 3 in 2024 are available without a prescription and are not claimable through health insurance extras. Higher-dose CBD prescribed via SAS or AP pathways may attract limited extras benefits from a small number of funds, as outlined in the table above. The product type, dose, and prescribing pathway all affect claimability.

Will coverage improve if more products get TGA registration?

TGA registration alone has not historically triggered private health fund coverage. PBS listing is the mechanism that drives broad pharmaceutical coverage under both Medicare and hospital insurance. A PBAC recommendation and subsequent PBS listing would represent a significant shift in the coverage landscape for registered products.

My doctor prescribed medicinal cannabis as part of a mental health plan — does that change my entitlements?

A mental health treatment plan under the MBS (e.g., a GP Mental Health Care Plan) covers the consultation, not the medicine. The prescription medicine itself remains subject to the standard PBS and health fund rules regardless of the clinical context in which it was prescribed. Discuss cost management options with your treating clinician.

Where can I get personalised advice about costs and coverage?

Your prescribing doctor or an accredited medicinal cannabis clinic can outline the likely ongoing costs for your treatment. For insurance-specific questions, contact your fund directly or speak with a health insurance broker registered with the National Insurance Brokers Association (NIBA). AusCannaHub does not provide financial or medical advice.

Sources

• TGA Medicinal Cannabis Hub — tga.gov.au
• Pharmaceutical Benefits Scheme — pbs.gov.au
• Private Health Insurance Comparison — privatehealth.gov.au
• Department of Health and Aged Care — Private Health Insurance — health.gov.au
• Australian New Zealand Clinical Trials Registry — anzctr.org.au
• APRA — Private Health Insurance Regulation — apra.gov.au