Affordability of psychedelic treatments remains a significant obstacle to widespread accessibility.
Breakthrough medical therapies bring relief to people enduring long-term illnesses. But these treatments often come with sticker shock.
Psychedelics are no different in this regard. As these therapeutic approaches become more widely accepted and move closer to regulatory approval, affordability remains a significant obstacle to widespread accessibility.
Consider that out-of-pocket costs for a series of IV ketamine treatments can be thousands of dollars and often require monthly maintenance doses to be fully effective.
The introduction of Spravato, the FDA-approved nasal-spray version of ketamine for treatment-resistant depression, increased insurance coverage of the drug. But when first introduced, the total one-month treatment cost for Spravato was estimated to be between $4,720 and $6,785, putting it out of reach for those with high-deductible plans. A lengthy pre-authorization process also complicates accessibility.
In the underground world of psychedelic therapists and guides, a single guided session can cost $500 or more. This doesn’t include pre- and post-integration sessions that can add hundreds, even thousands more to the final bill.
Advocates of psychedelic treatments understand what’s at stake.
Many have begun communicating to insurers the potential benefits of these therapies. At last year’s Horizons: Perspectives on Psychedelics conference in New York, psychedelic-medicine researchers and executives presented information showing how such treatments could help insurers save money, according to a Bloomberg news report. The article noted that mental-health spending in the United States is estimated to be more than $200 billion a year. More effective treatments could help curtail spending on traditional antidepressants, such as selective serotonin reuptake inhibitors, or SSRIs.
Whether insurers will listen remains to be seen, but progress is being made on several fronts.
On March 3, the American Medical Association published the acceptance of new current procedural terminology (CPT) III codes for psychedelic-assisted therapies. CPT is the coding system that medical billing offices use for coverage and reimbursement. CPT III is a temporary designation for emerging technologies, services and procedures. The Multidisciplinary Association for Psychedelic Studies, or MAPS, and Compass Pathways collaborated to work with the AMA to create the CPT III codes.
As MAPS noted, the first code (0820T) is for a health care professional to be reimbursed for monitoring and intervention during a psychedelic-assisted therapy. There are two additional modifiers (code 0821 and 0822) that are for reimbursement for a second qualified health care professional and for clinical staff, respectively.
“The development of these new codes highlights the potential role in mental health care that MDMA-assisted therapy may play in the future if approved by the FDA,” said Amy Emerson, CEO, MAPS Public Benefit Corp., in a July 6 news release announcing the codes. “Given mental health treatments have historically not been reimbursed adequately, it is great to see a new potential avenue for insurance coverage and reimbursement.”
In November, Enthea, which offers employers add-on coverage for psychedelic treatments, announced that it plans to include psilocybin-assisted therapy in employer-benefit plans for states that have legalized the medicine. The plan is a type of supplemental coverage similar to vision or dental plans that many employers offer their employees.
Earlier in the year, the company released its one-year results from the ketamine-assisted therapy benefit program it administers for Dr. Bronner’s, a company known for its natural soap brand. During the first year, 7% of Dr. Bronner’s health-plan members completed their physician-recommended ketamine treatment regimen, which includes medical and psychiatric intake, preparatory sessions, ketamine medicine sessions and therapy sessions to integrate the experiences into their daily lives. Dr. Bronner’s reported that participants in the plan showed significant improvements in their symptoms.
These advancements offer a glimpse of hope that, as these treatments become more mainstream, efforts to make them financially feasible will contribute to their broader availability, maximizing the potential benefits for individuals grappling with long-term illnesses.