One of the biggest concerns in the psychedelic industry is affordability.
Questions about translating psychedelic treatments from clinical trials to community clinics are being debated widely across various platforms and forums — but the right answer is yet to be known.
Last week, Balázs Szigeti, a research associate at Imperial College London, UK, tweeted that the long hours required for psychedelic-assisted therapy, a model which is currently being investigated, “will skyrocket the costs” of the treatment, as opposed to the widely-available SSRI supply that is cheaper and doesn’t require therapists to sit through during the administration of the drug.
A number of responses poured in, expanding on Szigeti’s query, and discussing what could potentially work to make psychedelic-assisted therapy affordable and equitable for patients. Scalability, safe supply, trained professionals, and commercialization appeared as some suggestions. These kind of conversations highlight the importance of the topic in the development of the industry.
In most places one month #SSRI supply is cheaper than an hour of therapy. If #psychedelics #therapy requires therapist(s) to sit through the long trips, as it is currently tested, that will skyrocket the costs. Has anyone written about this cost/scalability issue of psy therapy?
— Balázs Szigeti (@psybalazs) May 10, 2022
Can insurance coverage help?
Currently, 12-week-long ketamine-assisted therapy averages $6,000 — a treatment only accessible to those who are privileged enough to afford it.
Sherry Rais, co-founder of Enthea, told Microdose that psychedelic-assisted therapy lasts six months on an average. “It’s not years of therapy, and the treatment has an end to it unlike traditional therapy that could go on for years,” Rais said.
A non-profit organization, Enthea is a health plan administrator, helping health care providers, employers, and patients figure out insurance plans to expedite coverage for psychedelic-assisted therapy. The organization has a vision to provide safe, affordable access to psychedelic-assisted healthcare.
Since psychedelics continue to be controlled substances, insurance companies are not yet stepping up to provide coverage. Meanwhile, psychedelic-assisted therapy is increasingly gaining mainstream attention as an alternative to treating various mental health concerns.
But it isn’t just the cost of substances making the treatment unaffordable. Instead, the lack of trained professionals and long hours of administration hours can drive up the prices of the treatment. For instance, the phase III trials for MDMA-assisted therapy revealed the cost for each patient was $11,537.
Each of those patients in the trial received three 90-minute-long preparatory sessions, three 8-hour active MDMA or placebo sessions, and nine 90-minute-long integrative sessions.
The study noted that the “model conservatively distributes the reduction in health care costs over five years: no cost reduction in the first year following MDMA-assisted therapy and a 25 per cent of the reduction in each of the four successive years.”
Over a period of 10 years, MDMA-assisted therapy averts 27.5 deaths, and saves $46.6 million compared with standard of care. The cost of the therapy breaks even at 3.8 years, the study said.
Similarly, psilocybin-assisted therapy puts a patient in a $2000-$5000 cost framework. The cost of psilocybin mushrooms is incredibly low, but the cost of facilitation is high. Experts believe that the cost will get offset in the long run, similar to MDMA-assisted therapy.
In other words, psychedelic-assisted therapy may be more affordable in the long-run, with faster results that may stay longer with patients.
However, if the upfront cost of the treatment continues to be high, it will deprive many marginalized communities and everyday patients of access to psychedelics, making it no different from the conventional and pricey mental health treatments.
Rais noted that it’s “important to eliminate the cost barriers to the treatment, and we know larger insurance companies won’t provide coverage” for years to come, and as the psychedelic laws reform slowly (some major providers are beginning to cover ketamine treatments, but the list is small and access is still difficult).
Earlier this year, Enthea partnered with Dr. Bronner’s to create a benefit health care plan which would include ketamine-assisted therapy for the soap company’s employees — a first of its kind.
Rais said since the deal with Dr. Bronner’s, many employers are stepping up to create similar coverage plans for their employees. She added that this model could eventually get expanded for MDMA and psilocybin-assisted therapy coverage.
More than 13 million people in the U.S. are grappling with serious mental health illnesses, having an economic impact of $300 billion every year. A Lancet Commission report had predicted that mental health problems would cost the global economy at least $16 trillion by 2030. The numbers were released before the pandemic, which now could be an underestimation of the problem.
Affordable psychedelic-assisted therapy could help prevent the growing number of mental health issues, and this could be positive for both patients and the bottom line for insurance companies and employers. Psychedelic therapy or ketamine-assisted treatment has shown “to improve efficiency with their workforce by reducing absenteeism due to mental health issues,” Rais said.
Companies working on a safe supply of psychedelics
Scalability could resolve part of the problem of affordability by increasing the safe supply of psychedelic substances including psilocybin mushrooms and MDMA. Companies like Filament Health, Psygen, and Optimi Health are working to scale standardized amounts of natural psychedelic substances that could help researchers, health care workers, and patients in safe access.
Meanwhile, fewer regulatory restrictions would help lower the cost of therapy and help companies scale the supply of the substances more efficiently. But it will be some time before scalability is realized.
Experts believe that it would take at least three to five years before psychedelics could be seen in a mainstream clinical setting, being used as a viable treatment for mental health issues like treatment-resistant depression, PTSD, and severe anxiety.
Furthermore, a Global Initiative for Psychedelic Science Economics (GIPSE) is researching the economic and budgetary impacts of scaling access to psychedelic-assisted therapies including psilocybin and MDMA with MAPS, Johns Hopkins University, and Usona Insititute.
Oregon’s peer facilitation model
A lack of trained therapists and healthcare professionals has started to create a bottleneck for the emerging psychedelic treatment. But the upcoming regulatory framework for psilocybin use in Oregon may have an answer.
In its draft regulations, the Oregon Psilocybin Advisory Board (OPAB) proposed that under Measure 109, facilitators do not need to be from a health care background. Although, they will need to undergo a training of at least 120 hours of instruction, including lessons on preparation, administration, group facilitation, and so on.
Facilitators do not need additional degrees to enroll in the training program, other than a high school diploma. The concept of paraprofessionals facilitating psilocybin sessions would reduce the cost barrier and train a large number of peer facilitators, which otherwise would be expensive with psychologists and health care professionals.
Although it’s yet to see how the facilitator model plays out in Oregon, training programs have already started to flourish in the state. Fluence, for example, is an institute that offers training for psychedelic-assisted therapy, offering post-graduate certification in psilocybin-assisted therapy to qualify as a facilitator under M109, with the cost between $9,550 to $10,400.
The issue of therapist training is a vitally important issue for the future of the industry, one that requires a delicate balancing act: increasing the number of therapists to reduce costs and improve access; while also making sure to maintain high standards of therapist qualification to ensure patient safety.
Stay tuned to Microdose for more on this as it develops.