Ketamine infusions for mental health conditions are considered "off-label" and are currently not covered by insurance. Approximately 25% of all prescriptions in the US are written off-label and approximately 33% of psychiatric prescriptions are written off-label. Many of these prescriptions are indeed covered. The insurance networks are inconsistent in their application of this policy and it is not a good basis for them to deny coverage for ketamine infusions. Unfortunately, this is their current position. Hopefully, they will come to realize that ketamine infusions are more effective and less costly for them than other treatments they are currently covering. We will continue to fight for insurance coverage for all patients, as we have since 2014.
Ketamine Therapy Insurance Not Technically Covered but Aspects of Treatment Can Be?
Ketamine Treatments may not technically be covered by your insurer, but aspects of the treatment can be. Ketamine was approved by the FDA as an anesthetic in 1970. Ketamine Infusion Therapy for the treatment of mood disorders and chronic pain conditions is considered an “off-label” use. This simply means there is a clinical basis for using it to treat conditions other than what it was originally approved for. Prescribing medications off-label is a very common practice in the United States; 33% of all psychiatric medications are prescribed off-label and almost 25% of all medications are. Still, this can create limitations for insurance coverage.
So Why Doesn't the FDA Just Approve Ketamine For Depression?
The FDA approval process is very expensive and time-consuming. As a point of reference, the average time from FDA application to approval is 12 years, and the estimated average cost of taking a new drug from concept to market exceeds $1 billion. Since ketamine is already an approved drug with substantial safety and efficacy data, ketamine insurance coverage would likely be faster and less costly, but could still easily exceed tens or hundreds of millions of dollars and years of additional research. Since the patent is up on ketamine and no one company can recoup that cost, and it is already in use off-label, it isnt likely to be approved anytime soon. This is the case for many other medications that are used off-label. As a result, health insurance companies can deny coverage for ketamine infusions for the treatment of depression, other mood disorders, and chronic pain despite their efficacy. Unfortunately, the FDA doesn't approve medicines and insurance companies don't pay for them just because they can help people.
Is Getting Ketamine Covered by Insurance Possible with Off-Label Use?
While it is possible to get ketamine covered by insurance with it remaining off-label for mood disorders and pain conditions, there are many other hurdles to overcome. One of them is pharmaceutical companies do not want to see ketamine used therapeutically because it could reduce their sales of traditional antidepressants, which are highly profitable for them despite being less than half as effective. Insurance companies typically resist accepting ketamine as a credible treatment for depression, other mood disorders, and chronic pain because it is an off-label use. Generally, they tend to deny coverage of treatments whenever possible in an attempt to save money. At KCLA, we think they would actually save money if they covered ketamine instead of some of the less effective treatments they currently cover, many of which cost more than ketamine infusions.
Fortunately, there is an increasing awareness developing in the medical and psychiatric communities where ketamine therapy is acknowledged as a crucial procedure that needs to be “mainstream.” The United States and the rest of the world has an urgent need for solutions to the depression and suicide crisis. Depression is the leading cause of disability in the US and worldwide.
With the recent FDA approval of Spravato AKA esketamine (50% of ketamine’s molecules) for depression treatment, there is an increased chance that insurers may consider offering coverage for other ketamine treatments, such as Intravenous Ketamine Infusions.
How Do I Pay For Ketamine Therapy?
Ketamine Therapy may cost more than traditional treatments due to a lack of insurance coverage. However, you could actually save money in the long run if you’re able to finance these treatments on a short-term basis. When it comes to the cost of depression treatment, it’s important to prioritize your mental health.
- Understand your insurance coverage
- Compare costs of treatment providers
- Seek financing options
- Complete a cost-benefit analysis
Contact Us Today to Learn More About Ketamine Insurance Coverage
Ketamine Clinics Los Angeles is led by ketamine therapy expert Dr. Steven L. Mandel, a world-renowned pioneer known for his compassion and high success rate. Dr. Mandel has assembled a best-in-class team of providers in a state-of-the-art facility.
Your care team at KCLA provides ketamine infusion treatments to patients in Los Angeles, Westchester, Culver City, Beverly Hills, Venice, Marina del Rey, Santa Monica, the South Bay, Playa del Rey, Playa Vista, other parts of California, various states throughout the U.S. and even abroad.
Ketamine Clinics of Los Angeles is led by compassionate and experienced ketamine therapy expert Dr. Steven L. Mandel in a state-of-the-art facility. We have pioneered this treatment in a safe, relaxing, and professional environment. The KCLA team provides ketamine infusion treatments to patients in Los Angeles, Westchester, Culver City, Beverly Hills, Venice, Marina del Rey, Santa Monica, the South Bay, Playa del Rey, Playa Vista, other parts of California, various states throughout the U.S. and abroad. Contact us to learn more and to schedule your free phone consultation today.