Health insurance may soon cover your mushrooms and LSD, but not your medical marijuana

Health insurance has always been beneficial to the population, but some treatments have proven inaccessible for quite some time. Psychedelic therapy for mental health is one of those specialized treatments that’s been outside of the health insurance umbrella, but that could be about to change. There is evidence that health insurance companies are evaluating currently available data on the benefits of psychedelic treatment. Read on as we explain what this assessment could mean for optimistic patients hoping that insurance coverage for psychedelics treatment could be expanded.

A special collaboration took place in 2020 between the Multidisciplinary Association of Psychedelic Studies (MAPS) and Elliot Marseille regarding the assessment of health insurance for psychedelics. Marseille has represented the University of California as program director for cost-benefit analysis in medicine and public health. The collaboration aimed to clarify the perspective of healthcare payers on MDMA-assisted psychotherapy. The conclusion of the analysis was that psychedelics have come further than others in terms of research and development for insurance coverage. However, there is still a long way to go when health insurance companies offer treatment with psychedelics.

In their analysis, the research team used a decision-analytic model that demonstrated the costs and health benefits of treating patients with chronic or treatment-resistant PTSD. The model created by the research team was used to calculate medical costs, quality-adjusted life years (QALYs), mortality and incremental cost-effectiveness. The research team discovered a net saving of $103.2 million over 30 years compared to the continued standard of care. This was a significant discovery as it opened the eyes of many to the benefits of treatment with psychedelics, particularly from the perspective of healthcare payers.

Ketamine-assisted psychotherapy is currently the only FDA-approved psychotherapy available for patients with mental illness, but it is paid for out of pocket. This makes the treatment unattainable for many patients who largely need it. A full course of ketamine-assisted psychotherapy is reported to cost over $5,000 in the first year of treatment. This comes from information provided by Joseph del Moral, the CEO and co-founder of Field Tri. He shared this while attending a 2021 webinar at the Network for Excellence in Health Innovation. These costs include screenings, dosing therapy, integration therapy, and assessments. Another report from the Institute for Clinical and Economic Review puts the annual cost of ketamine treatment at $3,700 for the first year. This is still considerably high and largely unattainable for many people in need of treatment and has prompted cost-effectiveness measures.

Access to insurance for these treatments has increased significantly. Marseille also serves as the leader of the Global Initiative for Psychedelic Science Economics, an organization that provides insurance companies with data on psychedelics. The group consists of a network of health economists working on a variety of projects that will help open up access to insurance for patients treated with psychedelics. The team is currently working with the Usona Institute on the cost-effectiveness of psilocybin treatments for depressive disorders. It is also collaborating with Johns Hopkins University’s Center for Psychedelic and Consciousness Research to study the cost-effectiveness of psilocybin treatment for smoking cessation.

Fortunately, more research is now being done on the effectiveness of psychedelics in treating mental illness. These clinical studies have demonstrated the effectiveness of MDMA and psilocybin alongside a variety of other psychedelics. The growth of psychedelics has since been a welcome sight, as it helps alleviate addiction to drugs that are known to have worrisome side effects.

The increase in clinical trials has certainly caught the attention of insurance companies, and they are giving them some much-needed attention. The potency of these psychedelics seems poised to change the field of medicine in the long run, and no one wants to be left behind. According to a recent study, psilocybin has also been identified as useful in eliminating substance use disorders and tobacco addiction. The study reports that psilocybin can easily become a very useful tool that medical professionals can rely on to deal with such conditions. It is known to have a low risk of addiction and toxicity, and its supervised use is said to be ideal for dealing with patients predisposed to addiction.

While the studies tell a good story for psychedelics, more needs to be done before coverage can be achieved. While nothing is set in stone just yet, there are some recent moves that bode well for psychedelics reporting. One of these is the Affordable Care Act (ACA), which among other federal laws in the United States, requires most health insurance plans to cover some degree of tobacco cessation treatment.

Some health insurance companies have also taken the initiative and recently made strides in coverage. Novamind announced last November that it will begin billing four providers directly for intravenous ketamine in treatment-resistant depression. The affected health plans 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, a CBD hemp products company that offers ketamine psychotherapy as a benefit for its employees. The company is doing this in partnership with Numinus to help less and manage the stress and anxiety that could come with work. Program staff reported an overall increase in their creativity, productivity, and overall well-being.

The future for psychedelic treatment insurance coverage is bright as all the stars are aligned. Many states are already taking steps to decriminalize psychedelics, and medicinal psilocybin is currently legal in Oregon and Colorado. This creates a lucrative industry that insurance providers are sure to jump into to help lower healthcare costs for everyone

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