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Does insurance cover ketamine treatment?

Does Insurance Cover Ketamine Treatment?

Maybe you’ve heard about ketamine therapy as a therapeutic wonder drug for treating a variety of ailments, from depression and anxiety to chronic pain conditions, and you’re interested in finding out if it can offer the same symptom relief to you. Chances are, you’re also wondering: Does insurance cover ketamine treatment? And if it doesn’t, how am I supposed to pay for it?
In short, no; insurance does not cover ketamine treatment. However, the reasoning behind this answer is much more complex than the answer itself, and there are still options for receiving ketamine therapy without insurance coverage.
To better understand the reasoning, there are two things one must know about ketamine: 

  1. It is approved by the Food and Drug Administration (FDA)
  2. It is considered an off-label medication for some uses

Ketamine treatment is FDA approved. However, there are off-label applications.

So, What Is the FDA?

The FDA is the agency that approves the legalization of prescription drugs in the United States. For a drug to gain approval, the FDA must have access to the following information:

  • The dosage that people can safely take
  • The conditions that the drug can treat
  • The populations in which the drug has been tested
  • Evidence that the drug is safe and effective 

Once a drug is approved by the FDA, doctors may prescribe it to patients. One thing to keep in mind is that, while the drug may be FDA-approved, this approval only applies to specific uses. However, this doesn’t take away a doctor’s ability to prescribe the drugs to patients for other uses that are not FDA-approved. 
In fact, many doctors do this. This is what we call off-label medication. 

Off-Label Medication

Off-label prescribing is a legal use of pharmaceutical drugs that healthcare providers commonly practice. This occurs when a doctor prescribes a patient with a medication that is FDA-approved for a different condition than the one the patient has. 
For example, the drug spironolactone is FDA-approved for treating high blood pressure, heart failure, edema, and Conn’s syndrome. However, there are some instances when healthcare providers prescribe spironolactone to treat acne vulgaris in female patients. 
There are many reasons why a doctor might prescribe someone an off-label drug—the main one being they believe it will be effective and beneficial for the patient. Other reasons include:

  • The FDA-approved drug for a specific condition might be too expensive or inaccessible 
  • There is no FDA-approved drug to treat a specific condition a patient has
  • The FDA-approved drug has not been effective for the patient taking it
  • The patient is unable to take the FDA-approved drug due to severe side effects

Ketamine is FDA-approved for anesthetic and analgesic purposes. Other applications like nasal sprays are considered off-label.

Why is Ketamine Infusion Therapy Considered an Off-Label Medication if Ketamine is FDA Approved? 

Ketamine is an FDA-approved anesthetic and analgesic accessible in operating rooms and emergency centers. However, it is not FDA-approved for the treatment of any type of mood disorder. When Ketamine is used to treat depression, PTSD, OCD, bipolar disorder, anxiety, etc., it is considered an off-label use of the medication. 
Because it is an off-label use of medication, ketamine infusion therapy is not covered by insurance.

Is Ketamine Infusion Therapy Safe Then?

For over 50 years, ketamine has been used safely in millions of patients. It is also one of only two anesthetics listed as an “essential drug” by the World Health Organization (WHO). 
Medical studies have also shown that ketamine infusion therapy has improved symptoms of severe depression, PTSD, OCD, bipolar disorder, anxiety, and chronic pain conditions safely, with approximately 70–80% of patients responding to ketamine infusions. 

Types of Ketamine Therapy

There are two different types of ketamine therapy: IV infusion and nasal spray. 
The ketamine IV infusion is administered intravenously into the patient’s bloodstream. This treatment takes effect right away and typically lasts from days to weeks. Ketamine IV infusion therapy is commonly used to treat depression and bipolar disorder, but it is not a first-line treatment for depression. It is generally used if a person does not respond to two or more antidepressants. This is the most common and most effective form of ketamine therapy.
Esketamine (Spravato) nasal spray is the second form of ketamine therapy that is FDA-approved. This form reacts differently to neurotransmitter receptor sites in the brain, decreasing the effectiveness and increasing the side effects of the drug. 
Ketamine treatment may not be covered by insurance but there are financing options available.

Financing Options—Mindscape Ketamine & Infusion Therapy 

Although the answer to the big question, Does insurance cover ketamine treatment, is no, there are still plenty of options available for patients looking to treat their mood or chronic pain disorders with this drug. 
Many ketamine clinics that provide affordable ketamine therapy only accept cash or card for payment, which is generally required at the time of treatment. But there are many clinics that offer interest-free financing for qualified customers through a third-party medical lender. So, reach out to your local ketamine therapy provider to see if they have payment options that work for you.