After years of waiting, psychedelic medicines are on the verge changing treatment of major depression, post-traumatic stress disorder, substance abuse disorders, and other mental health issues. The long wait for an effective way to treat major risk factors for veteran suicide is also coming to an end. Australia has legalized treatments with psilocybin and MDMA for individuals with PTSD and depression. The USA is not far behind. Now some of the focus of psychedelic therapy will be on practical issues like who gets treated first, where do they go for treatment, and how much will psychedelic therapy cost.
What Will Psychedelic Therapy Be Like?
Taking a cue from how the Australians are rolling out psychedelic treatment we see that there will be numerous controls. At least initially, treatment will limited to those professionals with the skills and experience to make the best and safest use of these medicines. Patients will be screened to see which ones are most appropriate for therapy using psilocybin or MDMA. Individuals who do fine with current medicines will, at least initially, not be the ones who receive psychedelics. However, we expect that with time psychedelics will be used more and more. This is because they only require a dose or two instead of daily pills for months or even years. Treatment protocols will be set up requiring psychotherapy or coaching prior to use of psychedelics, during the use of these medicines, and after as well.
Because there may well be many more individuals who want and need this sort of therapy than there are facilities and professionals able to provide treatment, there will be waiting lists. It is unlikely that professionals will just be handing out pills because research has shown that psychedelics are very successful as adjunctive treatment along with coaching or psychotherapy and not necessarily when used on their own. In fact, there may well be situations where taking psychedelics would be useless or even dangerous without professional oversight.
Cost of Treatment with Psychedelics
The street cost of psilocybin can range from $5 to $2,000 depending on potency and strength. Prices are likely to be closer to the lower end when we are talking about legal medicines made by traditional pharmaceutical manufacturers. A 30-day supply of a traditional antidepressant like Zoloft runs less than $10. Thus the costs of treatment with psychedelics will have little to do with the pills. It will have do with hours spent with specially trained psychotherapists or coaches. According to a recent article in the Sydney Morning Herald, psychedelic treatments are likely to cost around $25,000 AUD. That is about $16,800 in US dollars. But, because the wage scale is higher for US professionals, we can probably expect closer to $25,000 US in the USA for a course of psychedelic treatment.
Will Insurance Cover Psychedelic Treatment?
The American Medical Association (AMA) has already approved insurance billing codes for psychedelic therapy. The odds of insurers covering psychedelic therapy will get better once MDMA and then psilocybin get FDA approval. As far as the cost of the medicines is concerned, we would not expect to see any argument from insurers who will expect to be paying less to reimburse for one or two psychedelic pills as opposed to three or four years of standard antidepressants.
The issue will be different for reimbursement of therapy sessions. For insurers, the issue will be costs over time. Insurers like United Health Care have gotten very good at tracking therapies and providers and determining who is most cost-effective over time in achieving good treatment results that last. If psychedelics save money for insurers, approval will swift. If they expect to be paying more money for these therapies we can expect them not to want to pay or provide limited treatment coverage.
Will the Veterans Administration Provide Psychedelic Treatment?
Service connected disabilities are covered by the VA. How much hassle will be involved in determining that at veteran’s PTSD is because of their time in Iraq? Will the VA have sufficient staff and other necessary facilities to offer competent psychedelic treatment? Because the VA is participating in studies of the efficacy of psychedelic therapy for PTSD patients, there is good reason to believe that services will be available. Now the question is how long a long-suffering veteran with PTSD who is at risk of suicide will need to wait and what sort of hoops they will need to jump through to receive treatment.