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The patients’ appeals have been dismissed, but Aurea Care’s legal battle continues. On 8 October, the Administrative Court in Stockholm received the clinic’s final submission, including new evidence on treatment outcomes, medical risks and consequences for healthcare. Aurea Care also requests clarification of Magnus Thyberg’s former role at Region Stockholm and any involvement in TLV’s handling of the case.
Aurea Care maintains its appeal against the Swedish Dental and Pharmaceutical Benefits Agency’s (TLV) decision to exclude oral extemporaneously prepared medicines containing dronabinol and cannabidiol from the high-cost protection scheme as of 1 December 2026.
The clinic requests that the decision be overturned or, alternatively, that the case be referred back to TLV for reconsideration. Aurea Care also requests an urgent stay of the decision, which would allow the subsidy to remain in place while the court proceedings are ongoing.
The Administrative Court has dismissed the patients’ appeals on the grounds that they lack standing to appeal. This means that their objections concerning the decision’s medical and financial consequences have not been examined on their merits.
Aurea Care’s appeal remains pending. The clinic invokes its independent responsibilities as a healthcare provider and the decision’s direct impact on its own operations. The question of the clinic’s standing to appeal has yet to be determined.
Follow-up shows pain relief and a reduced medication burden
The new evidence includes an anonymised compilation of Aurea Care’s internal follow-up of 100 patients.
Stable pain relief was recorded in 97 patients. For 85, other pain medication was reported to have been reduced or discontinued. Improved quality of life was recorded in 97.
The results describe the group of patients followed within the clinic’s practice. The follow-up is not a controlled clinical trial, but it documents treatment outcomes that Aurea Care believes must be taken into account before the financial conditions for continued treatment are changed.
The clinic argues that there are already patients receiving established treatment with documented benefits. If these patients lose the ability to pay for their medicines, the improvements achieved may be lost.
For a patient with chronic pain, deterioration can affect sleep, mobility, everyday life and the ability to work. A subsequent court ruling cannot be relied upon to immediately restore the health and function lost during an interruption in treatment.
A forced switch constitutes a medical change
The specialist opinions previously submitted to the Administrative Court explain why Sativex and Epidyolex cannot simply replace treatment with separate dronabinol and cannabidiol preparations.
Separate preparations allow THC and CBD doses to be adjusted independently. Sativex contains a fixed combination of the substances and is administered as an oromucosal spray. Epidyolex contains CBD and is approved for certain epilepsy conditions.
The differences therefore concern composition, dosing and the route of administration. Neither of the authorised products is approved for chronic pain.
The specialist opinion describes how individual dose adjustments can be crucial to balancing treatment benefits and side effects. Switching products may require renewed dose titration, closer follow-up and additional medical assessments.
The fact that medicines contain the same active substance therefore does not mean that they are medically equivalent for every patient.
Aurea Care objects to the absence of previous pharmacy dispensing records for Sativex or Epidyolex being used to support conclusions about inappropriate prescribing. A dispensing register shows which medicines have been collected. On its own, it does not explain why a doctor chose a particular preparation or why another option was considered unsuitable.
Specialist doctors warn of deterioration and a return to opioids
The specialist opinion on treatment interruptions describes risks of increased pain, poorer sleep and reduced functional capacity when an effective treatment is discontinued or changed.
For some patients, the consequence may be a need to resume previous pain medication. This could include opioids or other medicines that previously provided inadequate relief or caused troublesome side effects.
The opinion highlights risks associated with opioid treatment, including sedation, constipation, falls, tolerance, dependence and overdose. It also addresses withdrawal symptoms and the need for medically planned changes to treatment.
These risks do not mean that every patient will be affected. They mean that a treatment interruption forced by financial circumstances must be assessed as a medical issue.
Aurea Care therefore disputes the claim that the continued ability to prescribe medicines provides sufficient protection. A prescription does not help a patient who cannot afford to collect the medicine.
The pharmaceutical manufacturer APL also warned before the decision that a blanket exclusion could affect patients who had been prescribed extemporaneously prepared medicines on valid medical grounds.
The multimillion-krona claims never led to the announced court proceedings
The conflict has a longer history than TLV’s reassessment.
In 2024, Region Stockholm presented Aurea Care with a claim for almost SEK 10 million, plus interest. The region considered that the clinic’s prescribing had triggered improper payments under the pharmaceutical benefits scheme.
In April that year, the region’s lawyers stated that the claim remained in place and that they would provide further information on how and when the matter would proceed to court.
A separate multimillion-krona claim was made against Aureum Healthcare, a different legal entity. A draft statement of claim was also sent in that case.
According to Aurea Care, the announced lawsuits were never filed. Liability for damages was therefore not established through the promised court proceedings.
The region had reviewed patient records and criticised the prescribing. The clinic disputes those conclusions. The region’s assessments and financial claims must therefore be distinguished from findings established by a court.
Similarly, TLV’s conclusion that the subsidy system had been circumvented is not a court judgment establishing that Aurea Care or its patients acted fraudulently. In its final submission, the clinic objects that TLV has not presented any individual review of its patients’ medical records, treatment histories and medical indications demonstrating that the prescriptions lacked a medical basis.
Magnus Thyberg’s dual roles require clarification
Magnus Thyberg held a senior position at Region Stockholm before taking office as Director General of TLV on 1 January 2026. He had also previously served as Vice Chair of TLV’s Pharmaceutical Benefits Board.
Region Stockholm is also one of the parties whose information TLV explicitly cited as part of the background to its reassessment.
Aurea Care therefore requests clarification of whether Thyberg personally participated in the region’s preparatory work or positions concerning the prescribing that subsequently became the subject of TLV’s decision. The clinic also seeks clarification of whether he later participated in or influenced TLV’s handling of the case.
This could raise a conflict-of-interest issue if his earlier involvement and subsequent actions give grounds to question his impartiality.
The conflict-of-interest provisions of the Administrative Procedure Act also cover participation in the handling of a case that may influence the decision. The question is therefore not limited to who formally made or signed the decision.
Thyberg is not listed among the decision-makers in the TLV decision in question. However, the Board’s agenda for 20 August lists him as the presenter of an update from the Director General, before the item concerning extemporaneously prepared medicines. The agenda does not establish what role he played in the preparatory work.
His previous employment does not, in itself, establish a conflict of interest. However, Aurea Care identifies a specific circumstance that needs to be investigated: whether the same person first helped advance a position within the region and subsequently influenced an agency review in which the region’s information formed part of the evidence considered.
The clinic requests information about Thyberg’s involvement and whether any conflict-of-interest assessment has been conducted.
Patients’ treatment needs protection while the case is being examined
The supplementary submission also includes a work environment assessment in which all four doctors at Aurea Care report an increased workload. Three describe professional or ethical stress linked to the risk that patients may no longer be able to continue treatment the doctors consider medically justified.
The socioeconomic appendix describes possible consequences, including more healthcare consultations, treatment with other medicines, rehabilitation needs and a reduced ability to work. No net socioeconomic effect has been calculated, but the clinic calls for these consequences to be considered alongside pharmaceutical expenditure.
Aurea Care requests that patients receiving effective treatment be protected while the decision’s legal basis, medical consequences and handling are examined.
1 December is approaching. The clinic therefore requests that the Administrative Court urgently consider its application for a stay, before the withdrawal of the subsidy affects ongoing treatment.
Sources and supporting documents
- Aurea Care’s appeal of 10 September, supplementary submission of 1 October and final submission of 8 October 2026, case 20288-26.
- Specialist opinions on differences between the products and risks associated with treatment interruptions.
- Internal patient follow-up, socioeconomic assessment and work environment assessment.
- TLV’s decision of 20 August and the Board’s agenda for the same day.
- Letter from Region Stockholm’s lawyers dated 16 April 2024 and draft statement of claim against Aureum Healthcare.
- APL’s consultation response dated 16 June 2025. Document 149 APL.
- The Administrative Court’s decisions dismissing appeals on 5 October, including cases 20075-26 and 20121-26.
- The Administrative Procedure Act, Sections 16–18; government information on Thyberg’s appointment; and TLV’s information on the background to the reassessment. Swedish Parliament.
- Cannabis i Fokus’s previous investigation into the multimillion-krona claims and Aureum Life’s article on the specialist opinions. Cannabis i Fokus.