Is Ketamine Treatment Covered by Insurance?
Top points
- The United States mental health crisis affects nearly 50 million Americans.
- Ketamine is legally prescribed as an “off-label” medication for mental health treatment, which is why most insurance companies do not cover it for that use.
- There are some steps you can take with your insurance provider to help cover the cost of ketamine treatment.
The United States is in the midst of a mental health crisis. According to Mental Health America, 19.86% of adults are experiencing some form of mental illness, which equates to nearly 50 million Americans.
Originally developed as an anesthetic in the 1960s, ketamine was approved for medical use by the FDA in 1970. As the drug gained popularity for recreational use in the 1980s and 90s, it was designated a controlled substance in the United States in 1999.
In the 2000s, ketamine began to be studied for its use in alleviating symptoms of depression. A 2019 study found that “the rapid, profound, and sustainable antidepressant effects of ketamine seem poised to transform the treatment of depression.”
Ketamine works differently than traditional SSRIs (which usually target the neurotransmitter serotonin) by targeting a different neurotransmitter called glutamate. Ketamine creates a surge of glutamate which can provide rapid relief of depression symptoms while increasing the brain’s neuroplasticity to help form new neural connections and thought patterns.
A study from 2014 on ketamine’s effectiveness in treating treatment resistant depression (TRD) concluded that 71% of those treated with ketamine met response criteria, with 29% meeting remission criteria the day after treatment. A diagnosis of TRD is often given when a patient has tried two more medications and/or therapies with little to no improvement.
While ketamine treatment is showing many positive results, it is not currently covered by the vast majority of insurance plans. Extending coverage to ground-breaking and effective treatments such as ketamine is a crucial step to increasing access to affordable mental health treatment.
But while most insurance plans don’t cover ketamine treatment, there might be some steps you can take to help with the cost.
Why Ketamine Treatment Isn’t Usually Covered
Since ketamine is prescribed off-label for mental health conditions, many insurance companies don’t cover it. Off-label prescribing occurs when a medication is prescribed in a different way than originally approved for by the FDA. This is a legal and common practice. The Agency for Healthcare Research and Quality (AHRQ) estimates that one in five prescriptions written today is written for off-label use.
As ketamine hasn’t been approved by the FDA specifically to treat depression and anxiety, most insurers do not cover it. The good news is that there is current research advancing psychedelic medicines – including ketamine – toward FDA approval for mental health conditions.
In 2019, the FDA approved an intranasal ketamine-derivative spray called esketamine (under the brand name Spravato) for patients with treatment-resistant depression. But even coverage of Spravato varies among different insurance carriers.
Ways To Reduce Ketamine Treatment Cost
While coverage for ketamine treatment is limited, there are steps you can take to help offset the costs.
Before beginning your treatment, check with your insurance provider to find out if they provide any type of coverage to help defray the full cost of treatment. There are some providers who are willing to cover some up-front costs for IV ketamine treatment by designating it “an infusion of a generic drug,” for example.
Another step is to ask about out-of-network reimbursement, which the insurance provider will pay back after the treatment. Most insurance companies accept out-of-network claims for healthcare services but how they are paid is unique to each provider.
At-home Ketamine Treatment with Nue Life
Our mission at Nue Life is to provide accessible and effective treatment for those who need it. Our at-home oral lozenge ketamine is one of the most affordable methods of ketamine treatment available.
Ketamine treatment via infusion can cost anywhere between $400 to $2000 per treatment, whereas the at-home treatments available from Nue Life begin at $153 per treatment.
In addition, all Nue Life programs include health coaching and group integration sessions. This ensures that you have the support to use the insights from your ketamine treatments to create lasting change.
If the out-of-pocket expense is still a challenge, Nue Life offers financing plans through Walnut to help you pay over time.
You may also be able to use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for your ketamine treatment. HSAs and FSAs are tax-advantaged accounts that allow you to set aside money for qualified healthcare expenses designated by the IRS. Check with your benefits provider to see if ketamine treatment qualifies.
The Future of Ketamine Treatment Coverage
As research continues to show ketamine to be a safe and effective mental health treatment, insurance companies will have to acknowledge it as a viable treatment worth covering.
There are also lobbying efforts underway from medical specialists and patients to cover ketamine treatment for both mental health and physical pain management.
The Ketamine Taskforce is a nonprofit organization working with regulators to change how ketamine is covered. Launched in February of 2021, this organization is advocating for ketamine as a mental health treatment for patients who are unable to pay out of pocket.
Invest in Your Mental Health
Ketamine treatment is a promising therapeutic option for addressing mental illness that can provide rapid relief by increasing the brain’s neuroplasticity to create new thought patterns and self-acceptance.
It’s natural to feel unsure about beginning a new treatment program, especially when your insurance plan doesn’t cover it. However, the potential benefits of ketamine treatment could be a sound investment in your overall health and wellness.
Treatment at Nue Life
Nue Life believes in holistic treatment, meaning that what happens after your ketamine experience is equally as important as the experience itself. We want to ensure you have meaningful takeaways from your experiences and help you establish positive new neural pathways.
That’s why we provide one-on-one health coaching and integration group sessions with our programs. We’re here to help map out the mind and body connections in your brain and help you discover the real insights that lead to real relief.
Sources
Ketamine: A Paradigm Shift for Depression Research and Treatment | Neuroview
How New Ketamine Drug Helps with Depression | Yale Medicine
Ketamine: 50 Years of Modulating the Mind | National Institutes of Health
The Role of Ketamine in Treatment-Resistant Depression: A Systematic Review
.png)
