Medical insurance has always been beneficial to the populace but some treatments have long proven inaccessible for quite some time. Psychedelic therapy for mental health is one of those special treatments that has been outside of the umbrella of medical insurance but that might soon change. There is existing evidence that medical insurance providers are currently assessing available data on the benefits of psychedelic treatment. Read on as we explain what this assessment could mean for optimistic patients hoping insurance coverage could expand for psychedelics treatment.

Assessing the cost-effectiveness of psychedelics therapy

A special collaboration occurred in 2020 between the Multidisciplinary Association of Psychedelic Studies (MAPS) and Elliot Marseille regarding assessing medical insurance for psychedelics. Marseille has represented the University of California as the course director of cost-effectiveness analysis in medicine and public health. The collaboration was aimed at positing the healthcare payer’s perspective on MDMA-assisted psychotherapy. The product of the analysis was that psychedelics have come further than others in terms of research and development for insurance coverage. There is however a considerable amount of work still left to be done if insurance providers are going to provide psychedelics treatment.

In its analysis, the research team made use of a decision-analytic model which showed the costs, and health benefits of treating patients with chronic or treatment-resistant PTSD. The model which the research team built was used to calculate medical costs, quality-adjusted life years (QALYs), mortality, and incremental cost-effectiveness ratio. A net savings of $103.2 million across 30 years compared to the continued standard of care was discovered by the research team. This was a significant discovery as it opened the eyes of many to the benefits of psychedelics treatment, especially through the healthcare payer’s eyes.

Ketamine-assisted psychotherapy is presently the only FDA-approved psychotherapy available for mental health patients but this is paid for out-of-pocket. This makes the treatment out of reach for many patients who are largely in need of it. A full course treatment of ketamine-assisted psychotherapy is set to be over $5,000 in its first year of treatment. This is according to information from Joseph del Moral who is the CEO and co-founder of Field Tri. He shared this while attending a 2021 webinar at Network for Excellence in Health Innovation. This cost includes screenings, dosing therapy, integration therapy, and evaluations. Another report from The Institute for Clinical and Economic Review places the annual costs of ketamine treatment at $3,700 in its first year. This is still considerably high and is largely out of reach for many people in need of the treatment and has prompted moves for cost-effectiveness.

Increase in clinical trials and research on psychedelics

There has been considerable growth being made regarding the accessibility of insurance for these treatments. Marseille also doubles as the principal of the Global Initiative for Psychedelic Science Economics, an organization providing insurance companies with data on psychedelics. The group consists of a network of health economists working on a host of projects that will help open doors of access for insurance to patients on psychedelics treatment. The team is presently working alongside the Usona Institute on the cost-effectiveness of psilocybin treatments for depressive disorders. It is also collaborating with the Centre for Psychedelic and Consciousness Research of John Hopkins University regarding the cost-effectiveness of psilocybin treatment for the cessation of smoking.

Thankfully more research is now being done on the effectiveness of psychedelics for the treatment of mental health conditions. These clinical trials have shown the effectiveness of MDMA and psilocybin among a host of other psychedelics. The growth of psychedelics has since been a welcomed sight as it helps relieve the dependence on medications which are known to have worrying side effects.

The growth in clinical trials has certainly caught the eye of insurance companies and they are paying much-needed attention. The effectiveness of these psychedelics looks poised to change the scope of medicine by a long shot and no one wants to be left behind. Psilocybin has also been identified as being useful in eliminating substance-use disorders and tobacco addiction according to a recent study. The study reports that psilocybin can easily become a very useful tool that medical professionals can rely on for dealing with such conditions. It is known to have a low risk of dependence and toxicity and its supervised use is termed ideal doe dealing with patients predisposed to addiction.

What should we expect?

While the trials tell a good story for psychedelics, there is still more to be done before coverage can be achieved. Though nothing is set in stone yet, there are some current moves that spell good tidings for the coverage of psychedelics. One is the Affordable Care Act (ACA) which is one among other federal laws in the US which require most health insurance plans to cover tobacco cessation treatments to some level.

Some health insurance providers have also taken the initiative and made strides for coverage recently. Novamind announced last November that it will commence direct billing of intravenous ketamine for treatment-resistant depression under four providers. The concerned health insurance providers are MBA Benefit Administrators, PEHP Health & Benefits, the University of Utah, and Blue Cross Blue Shield. 

 Other positive moves have also been made by Hemp Lucid which is a CBD hemp products company offering ketamine psychotherapy as a benefit for its employees. The firm is doing this in conjunction with Numinus to help less and manage the stress and anxiety that might come with work. The employees in the program reported a general increase in their creativity, productivity and all-round wellness.

Bottom line

The future is bright for insurance coverage of psychedelic treatments seeing as all the stars are aligning in the right way. Many states are taking steps to decriminalize psychedelics already and medical psilocybin is currently legalized in Oregon and Colorado. This creates a lucrative industry that insurance providers will surely be considering jumping into in order to help reduce healthcare costs for all 

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