STJ: Health insurance plans are not required to cover cannabidiol

Health insurance providers are not compelled to bear the costs of cannabidiol (CBD)-based medications intended for home use. Financial coverage of the drug by companies in the sector is only mandatory if there is express support in legislation, in contracts signed with patients, or in applicable regulations.

The determination was ruled by the Second Section of the Superior Tribunal de Justiça (STJ). The case was judged in a virtual session that concluded on Wednesday, October 14.

The decision rendered by the Superior Court establishes an understanding that, from now on, will bindingly guide the judiciary throughout the national territory. The measure unifies judicial decisions and ratifies well-established case law that had been reported by Portal Sechat.a well-established case law that had been reported by Portal Sechat.

The thesis established in REsp 2,260,165

In a single virtual act, the STJ magistrates recognized the relevance of the federal issue surrounding the matter and established a binding legal thesis. The panel unanimously upheld the decision under Special Appeal (REsp) 2,260,165.

The official text unifying the judiciary's interpretation on the subject establishes that:

“Health insurance operators are not required to cover cannabidiol-based medications for home use when there is no legal or contractual provision for coverage, except in cases expressly provided for by governing legislation or applicable regulatory norms; mere import authorization is not sufficient to expand the scope of the contract or remove legitimately provided coverage limitations.”

Import authorized by Anvisa does not create a duty to cover costs

One of the central points of the deliberation involved the role and decisions of the Agência Nacional de Vigilância Sanitária (Anvisa). For the reporting justice, the exceptional import authorization granted by the agency is under no circumstances to be confused with a duty of coverage by health plan operators.

According to the Court's analysis, the license issued by the health surveillance agency serves exclusively to resolve the product's regulatory standing in Brazil.

The fact that Anvisa grants the import license merely remedies the absence of sanitary registration. This does not alter the home-use nature of the medication, nor does it have the power to elevate it to the mandatory coverage list of health insurance providers.

Consolidated interpretation and the legal basis

The reporting of this historic case was overseen by Justice Sérgio Kukina, current president of the Comissão Gestora de Precedentes, Jurisprudência e Ações Coletivas (Cogepac). A noteworthy internal procedural aspect of the trial is that, although the justice originally belongs to the First Section of the STJ, he led the case decided by the Second Section fully supported by the new internal operating rules.

In substantiating his vote, the reporting justice expressly invoked the legal, economic, and social magnitude of the coverage controversy. Kukina pointed out in his arguments that there were already more than 700 rulings from the Third and Fourth Panels of the STJ addressing the same subject.

The basis used in such a high volume of prior rulings was Article 10, item VI, of Law 9,656/1998. This statutory provision allows providers to exclude medications classified for home use from coverage, safeguarding only strictly legal, contractual, or regulatory exceptions.

The inaugural milestone of the summary proceeding

In addition to its major impact on private healthcare, the ruling holds significant technical importance, serving as the inaugural milestone of the so-called summary proceeding. This modality was recently established by the new appellate filter of the Superior Tribunal de Justiça, regulated under Court Rule Amendment (Emenda Regimental) 55/2026.

Under the new guidelines of the Amendment, the two-phase proceeding was chosen as the general rule. This standard format divides the analysis into two distinct stages: first, the assessment of relevance is conducted in a virtual session; subsequently, the examination on the merits takes place in an in-person session with the magistrates.

However, the same amendment provides for an exception. In the face of largely dominant case law in the Court—a scenario proven by the consistency of the more than 700 surveyed rulings—the rule allows for the use of the expedited, single-step path. The reporting justice concluded that this massive repetition of decisions showed that the matter was fully mature to become a qualified precedent.

It was this expedited track that the cannabidiol medication case inaugurated. This avenue established the binding precedent in a single, virtual deliberation, setting mandatory and definitive parameters for the entire country.