Is ketamine treatment ever covered by health insurance?
The answer to this question is yes and no. In certain circumstances, ketamine is covered by health insurance. Generally, the rule is that if a medical treatment is FDA approved, it may possibly be covered by health insurance.
So, is ketamine FDA approved. Yes, it is. Ketamine has been approved for medical use for over fifty years. However, the original approved use of the drug was for use as an anesthetic for surgery and other medical procedures.
Fortunately, doctors are able to use ketamine for other uses, such as to treat depression, anxiety, OCD, PTSD, suicidality, drug addiction, alcohol addiction, chronic pain, neuropathic pain, bipolar disorder, migraines, and more. When the drug is used for purposes that are not FDA approved, we call it off-label use.
The problem with insurance coverage for ketamine IV infusion therapy for these many different conditions is that being off-label, it is not FDA approved for these uses. Yet, there is a way to get ketamine therapy covered by insurance for the treatment of depression.
There is one form of ketamine, esketamine, that is covered by health insurance, because it is FDA approved.
Esketamine is an isomer of ketamine. It is the left-handed form of the molecule. The full ketamine drug is also known as racemic ketamine.
The brand name for esketamine is Spravato. Since Spravato is FDA approved for treating depression, many health insurance companies do cover it.
Spravato is not approved for other conditions, such as anxiety, OCD, PTSD, or the other many conditions that IV ketamine can be used for off-label. Doctors who administer Spravato do so under strict regulations, and must only use it for treatment-resistant depression.
How does Spravato differ from IV ketamine? Spravato is a nasal spray which is sprayed in the patient’s nose once weekly. IV ketamine infusion, on the other hand, is often administered several times weekly for around six to eight sessions.
Where Spravato is given indefinitely to continue treating depression, IV ketamine is considered to have lasting effects, so the patient does not need to return for IV infusions on a regular basis, after they have completed the initial series.
Should I get Spravato esketamine therapy, since my insurance covers it?
If you are considering ketamine assisted therapy, and you are concerned about the cost of IV ketamine infusion treatments, you may want to look into the possibility of getting Spravato therapy.
However, insurance coverage should not be the only deciding factor for commiting to a particular medical treatment. If you decide that you would benefit more from ketamine IV infusion therapy over Spravato nasal spray therapy, it may be worth looking into ways to finance the treatment. You may also want to look into discount programs at local clinics and price shop in your area.
Additionally, you should ensure that the ketamine clinic you go to includes psychotherapy and integration therapy as part of the program. Make certain that the ketamine facility that you choose is properly credentialed and highly rated. Price should not be your only deciding factor.
When you have decided to look into ketamine therapy as a solution for depression or other conditions, it is a good idea to speak with your primary care doctor. Ask your doctor if they think that ketamine treatment might be a good idea to help with treatment-resistant depression. If your doctor is not prepared to discuss ketamine treatment with you, you may want to schedule a consultation appointment with a medical ketamine consultant.
