Cannabidiol: patient fears losing treatment following STJ ruling

Leonardo Machado Coelho Monteiro, 34, is a federal civil servant living with hard-to-control epilepsy. His treatment combines cannabidiol and other medications. For him, the continuation of this combination is not an issue that can simply be resolved by replacing a product or cutting a monthly expense. According to him, the medication is part of a treatment he cannot interrupt, which would cost between R$ 4,000 and R$ 5,000 per month if he had to pay for it out of pocket.

“If they take cannabidiol out of my life, I don’t know what I’ll do. One thing I know for sure: I cannot afford it financially,” Leonardo states.

His account highlights one of the concerns surrounding the ruling by the Superior Tribunal de Justiça (STJ), which restricted the obligation of private health insurance plans to cover cannabidiol-based medications intended for home use. For patients who rely on court-ordered or contractual coverage to maintain their treatment, this interpretation could represent an additional barrier to access.

On October 14, 2026, the Second Section of the STJ unanimously established a legal thesis stating that operators are not required to cover cannabidiol-based medications for home use when there is no statutory or contractual provision for coverage, except in cases expressly provided for by legislation and regulatory standards. The court also determined that an import authorization granted by the Agência Nacional de Vigilância Sanitária (Anvisa), on its own, does not oblige health plans to pay for the product.

The decision consolidates an understanding that should guide similar cases in lower courts. However, the scope of this legal thesis and its exceptions must be evaluated according to the specifics of each treatment, contract, and the legal status of the patient.

Continuous treatment and costs the patient cannot afford

In Leonardo’s case, the concern is the possibility of losing a part of the treatment he considers essential for managing his epilepsy. He explains that cannabidiol is used alongside conventional medications and that he does not have the financial means to bear the monthly cost alone.

During his interview, Leonardo mentions the risk of SUDEP, an acronym for sudden unexpected death in epilepsy. The condition is a recognized concern in epilepsy, particularly in drug-resistant cases, although individual risk depends on specific clinical factors. It cannot be stated, without a medical evaluation, that discontinuing a medication will necessarily lead to this outcome.

Nevertheless, the account illustrates the scale of uncertainty experienced by patients who depend on the continuation of prescribed treatments and face difficulties affording them.

The debate is not limited to the paying capacity of a single patient. It affects individuals with chronic illnesses, families who organize their budgets around long-term treatments, and beneficiaries who have turned to the courts to obtain coverage for cannabis-based medications.

Lawyer notes that ruling does not eliminate all coverage possibilities

For Carla Coutinho, an attorney specializing in Cannabis Law, the ruling represents yet another challenge for patients, but does not mean that all possibilities of obtaining coverage have been eliminated.

“This decision does not mean that the patient has lost all possibilities of obtaining treatment coverage from their health plan, but rather that it has become more difficult,” she explains.

According to the lawyer, the first step is to submit the prescription and medical report to the health plan provider and formally request coverage for the medication. In the event of a denial, she recommends requesting a written justification and filing a complaint with the Agência Nacional de Saúde Suplementar (ANS).

The possibility of challenging the denial in court will depend on the specifics of the treatment and applicable contractual terms, among other factors.

“In summary, the STJ narrowed the circumstances for mandatory coverage, but did not extinguish patients' rights to challenge unwarranted denials,” Carla affirms.

This assessment is key because the court's thesis does not mandate an automatic cutoff of all treatments currently covered. The maintenance of coverage will depend on each beneficiary's situation and the existence of a statutory, contractual, or regulatory basis that justifies coverage.

Associations fear impact on low-income patients

Marilene Esperança, president of AbraRio, expresses concern over the ruling's effects on members who take high doses of cannabis oil and cannot afford the cost of treatment.

According to her, some patients receive court-mandated funding to purchase the product, while others have their treatment covered by health plans. The association is currently assessing, alongside its legal team, alternatives to address this new scenario.

“It is a very difficult situation for these patients who take the oil in high doses and already pay a very high amount for private health insurance,” Marilene says.

The leader also calls attention to families who commit a significant portion of their income to health plan premiums to ensure medical care, rehabilitation, and peace of mind during hospitalizations. When the need arises for an additional treatment that does not fit into the family budget, coverage can become decisive for the continuity of care.

Marilene mentions the case of her own son, Lucas, who receives home care services, with assistance from healthcare professionals and the provision of medical supplies. Although she notes that she does not depend on the health plan to obtain the cannabis oil used by her son—since she has access to treatment through her role at the association—she questions the plight of families who lack that alternative.

“How many mothers live on the minimum wage, on the LOAS benefit, and spend a large part of that income to pay for private health insurance?” she questions.

For her, the discussion must consider the real-world conditions of access to prescribed treatments, especially among families unable to absorb additional expenses.

What the STJ decided regarding cannabidiol

The legal thesis established by the Second Section of the STJ rules that health insurance plans are not required to cover cannabidiol-based medications for home use in the absence of a statutory or contractual provision for coverage, except in cases expressly provided for by legislation or applicable regulatory rules.

The court also clarified that exceptional import authorizations granted by Anvisa are not equivalent to an obligation of coverage by health plan operators.

The issue involves the interpretation of Law No. 9,656/1998, which regulates private health care plans and establishes, as a general rule, the exclusion of medications for home use from mandatory coverage, subject to legal, contractual, and regulatory exceptions.

This does not mean that every request for coverage is automatically dismissed. Situations involving contractual provisions, specific legal circumstances, or medications administered under conditions requiring professional assistance may require individualized review.

The decision also does not prohibit the medicinal use of cannabidiol nor prevent its importation when authorized. The focal point is the obligation of coverage by health insurance operators.

Access to treatment remains under debate

The accounts of Leonardo, Carla, and Marilene illustrate different dimensions of the controversy: the fear of losing continuous treatment, the legal hurdles in challenging a denial, and the financial impact on patients and families.

The STJ decision establishes a legal benchmark for similar cases, but practical consequences will depend on how the thesis is applied to each situation. For patients, legal guidance and a detailed review of the prescription, contract, and grounds for denial may be critical in determining which alternatives remain available.

Official sources:

• STJ — decision of October 14, 2026: Court establishes legal thesis on coverage of cannabidiol-based medications for home use. Primary source for legal grounds and scope of the thesis.

  

  Superior Tribunal de Justiça

   

• STJ — prior precedent: Health plan is not required to cover cannabidiol-based medication intended for home use and not listed by ANS. Explains previous understanding and exceptions related to coverage.

  

  Superior Tribunal de Justiça

   

• ANS — official portal: Agência Nacional de Saúde Suplementar. Channel to consult official statements and request clarification from the agency.

• Previous report by Sechat: STJ: health insurance plans are not required to cover cannabidiol.