Medicinal cannabis prescribing regulations by state

Expert overview of medicinal cannabis access, TGA regulations, and state-specific requirements for professional insurers

Published 3 April 2026

Introduction

Medicinal cannabis has become an increasingly relevant treatment consideration in Australian insurance claims, particularly for pain management, spasticity, and other conditions. Access to medicinal cannabis in Australia is regulated by the Therapeutic Goods Administration (TGA) at the national level, with state-based legislative frameworks providing additional governance. For professional indemnity insurers managing claims involving medicinal cannabis, understanding both national TGA requirements and state-specific regulations is essential to appropriate governance and coverage decisions.

This article provides a comprehensive overview of medicinal cannabis prescribing regulations across Australian states and TGA access pathways.

National TGA Framework for Medicinal Cannabis

Medicinal cannabis is regulated by the TGA under the Therapeutic Goods Act 1989 (Cth). Key regulatory elements include:

• Therapeutic Goods Register (TGR): Some cannabis-based products may be listed on the TGR where they meet TGA approval requirements for efficacy and safety.
• Special Access Scheme (SAS): The SAS provides a pathway for access to medicinal cannabis products not yet registered on the TGR, including categories A and B.
• Authorized Prescribers: Currently, medicinal cannabis can only be prescribed by authorized doctors, and in some states, nurse practitioners or other authorized practitioners.
• Patient Eligibility: Medicinal cannabis is indicated for specific conditions including refractory epilepsy, certain chemotherapy-related nausea and vomiting, and chronic non-cancer pain, subject to certain criteria.

TGA Special Access Scheme (SAS) Pathways

The TGA Special Access Scheme provides two primary pathways for medicinal cannabis access:

• SAS-A (Unrestricted): Available through licensed supply services for certain approved products, with streamlined access for eligible patients. Limited availability in current context.
• SAS-B (Restricted): Case-by-case TGA assessment of individual patient applications. Requires clinical justification and appropriate patient selection.

The majority of medicinal cannabis prescribing in Australia currently occurs through the SAS-B pathway, requiring individual TGA approval for each patient.

Approved Indications for Medicinal Cannabis

While clinical evidence for medicinal cannabis remains limited in some areas, recognized indications include:

• Refractory epilepsy: Particularly in pediatric populations with specific seizure disorders.
• Chemotherapy-related nausea and vomiting (CINV): Where conventional treatments are inadequate.
• Chronic non-cancer pain: Subject to specific criteria and failure of conventional therapies.
• Spasticity: Related to multiple sclerosis or spinal cord injury, where conventional therapies are inadequate.
• Other conditions: Case-specific applications where clinical evidence supports potential benefit.

Insurance practitioners should expect that medicinal cannabis prescribing is limited to these indicated conditions and supported by appropriate clinical documentation and evidence of conventional therapy failure.

New South Wales Medicinal Cannabis Regulations

New South Wales has established a medicinal cannabis prescribing framework supporting TGA pathways. Key elements include:

• Registered medical practitioners authorized to apply for SAS-B access.
• Specific requirements for patient selection and informed consent.
• Documentation and record-keeping obligations for prescribers.
• SIRA oversight of medicinal cannabis in workers compensation claims.

NSW health services have published guidance supporting appropriate medicinal cannabis access within TGA frameworks, with emphasis on evidence-based selection and monitoring.

Victoria Medicinal Cannabis Regulations

Victoria has implemented a medicinal cannabis prescribing framework aligned with TGA requirements. Key features include:

• Medical practitioners authorized to apply for SAS-B medicinal cannabis access.
• Patient eligibility criteria and informed consent requirements.
• Documentation of clinical indication and conventional therapy failure.
• WorkSafe oversight of medicinal cannabis in workers compensation context.

Victoria has established guidance materials supporting appropriate medicinal cannabis prescribing within evidence-based frameworks.

Queensland Medicinal Cannabis Regulations

Queensland has established medicinal cannabis access aligned with TGA requirements. Requirements include:

• Medical practitioner authorization for SAS-B applications.
• Patient selection based on approved indications and conventional therapy failure.
• Informed consent and documentation requirements.
• Insurance and workers compensation framework oversight.

Queensland Health has published guidance supporting appropriate medicinal cannabis access within evidence-based frameworks.

Western Australia Medicinal Cannabis Regulations

Western Australia operates medicinal cannabis access through TGA frameworks with state-based oversight. Key requirements include:

• Medical practitioner authorization for SAS-B applications.
• Patient eligibility assessment based on clinical indications.
• Documentation of clinical justification and conventional therapy failure.
• WorkCover WA oversight in workers compensation claims.

South Australia Medicinal Cannabis Regulations

South Australia supports medicinal cannabis access through TGA special access pathways. Key elements include:

• Medical practitioner authorization for TGA SAS-B applications.
• Patient selection criteria based on approved indications.
• Documentation requirements and informed consent.
• Insurance framework oversight and monitoring.

Other States and Territories

Tasmania, Australian Capital Territory, and Northern Territory operate medicinal cannabis access through TGA national frameworks with local regulatory oversight. All states require medical practitioner authorization and compliance with TGA SAS-B requirements for patient-specific access.

Medicinal Cannabis and Insurance Claims

Medicinal cannabis presents specific governance considerations for insurers:

• Indication appropriateness: Prescribing should align with recognized indications supported by clinical evidence.
• Conventional therapy failure: Documentation should demonstrate failure or inadequacy of conventional treatments prior to cannabis prescribing.
• TGA approval: Coverage should be contingent on appropriate TGA SAS-B approval or TGR listing.
• Monitoring and review: Regular assessment of efficacy and appropriateness should be documented.
• Informed consent: Documentation of patient information and informed consent regarding medicinal cannabis use.

Evidence Base and Clinical Considerations

The clinical evidence base for medicinal cannabis varies by indication:

• Strong evidence: Refractory epilepsy (particularly childhood seizure disorders), chemotherapy-related nausea and vomiting (specific contexts).
• Moderate evidence: Chronic pain (specific subtypes), multiple sclerosis-related spasticity.
• Limited evidence: Other indications for which case-by-case SAS-B applications may be considered.

Insurance practitioners should consider the strength of evidence for the clinical indication when assessing medicinal cannabis coverage decisions.

Medicinal Cannabis Products and Formulations

Medicinal cannabis products accessed through TGA pathways include:

• Oil-based formulations: Most common form accessed through SAS-B, containing cannabidiol (CBD) and/or tetrahydrocannabinol (THC).
• Dried flower: Some patients access dried cannabis for vaporization or other consumption methods.
• Capsules and tablets: Standardized formulations with specified CBD or THC content.

Product formulation and composition should be documented in prescriber records, with attention to CBD-THC ratios and potency.

Safety and Monitoring Considerations

Medicinal cannabis prescribing should include appropriate safety monitoring and assessment:

• Baseline assessment: Documentation of baseline cognitive, psychiatric, and functional status prior to initiating cannabis.
• Drug interactions: Assessment of potential interactions with other medications, particularly those metabolized by CYP3A4 and CYP2C19.
• Adverse effects: Monitoring for dizziness, cognitive effects, mood changes, or other cannabis-related side effects.
• Efficacy assessment: Regular assessment of whether medicinal cannabis is achieving therapeutic benefit.
• Dependence risk: While less concerning than opioids, cannabis dependence risk should be monitored and discussed.

Medicinal Cannabis and Functional Capacity

For workers compensation and insurance claims involving return-to-work considerations, medicinal cannabis functional impact should be assessed:

• Cognitive effects affecting work capacity in safety-critical or cognitively demanding roles.
• Motor coordination or balance effects relevant to specific work duties.
• Dizziness or other acute effects impacting work safety.
• Interaction with other medications affecting functional capacity.

Best Practice for Medicinal Cannabis Governance

For insurers managing claims involving medicinal cannabis, best practice governance includes:

• TGA compliance: Verify appropriate TGA authorization for medicinal cannabis access.
• Clinical justification: Document clinical indication and evidence base for prescribed cannabis product.
• Conventional therapy documentation: Confirm that appropriate conventional therapies have been trialed.
• Informed consent: Verify patient information and consent documentation.
• Monitoring: Establish regular review of efficacy and adverse effects.
• Functional impact: For insurance claims, assess functional implications of medicinal cannabis use.

Future Developments in Medicinal Cannabis Regulation

Medicinal cannabis regulation in Australia continues to evolve. Potential future developments include:

• Increased TGR listings of cannabis-based products as clinical evidence strengthens.
• Expanded SAS-A access for approved indications.
• Refinement of prescriber authorization requirements and training standards.
• Evolving clinical evidence supporting broader indications.

Insurance practitioners should maintain awareness of regulatory changes and adapt governance practices accordingly.