June 10, 2023 / By

Breaking the Taboo: The Case for Reimbursing Psychedelic-Assisted Therapy in the US Healthcare System

Breaking the Taboo: The Case for Reimbursing Psychedelic-Assisted Therapy in the US Healthcare System

 Psychedelic-assisted therapy is an emerging and polarizing field in the healthcare industry, with substances like psilocybin and MDMA showing potential in treating mental health and substance use disorders. However, their legality remains a major obstacle to their adoption in therapy. Assuming these therapies become widely accepted, health insurance companies will have to consider how to reimburse providers for this type of treatment.

One possible reimbursement model is the fee-for-service model, similar to how insurance companies currently reimburse for other forms of therapy or medical treatment. Another model to consider is a value-based payment model, which could be more complex but would focus on achieving specific health outcomes for patients.

Limiting the number of eligible providers could also be a possibility based on certain metrics like training, experience and adherence to safety protocols when administering these substances.

The reimbursement model for psychedelic-assisted therapy will likely hinge on several factors, including the regulatory landscape, availability of qualified practitioners, and insurance companies’ willingness to offer this treatment.

Another area of emerging interest is the intersection of psychedelics and outpatient retail pharmacy. As these drugs become more accepted and legalized, it opens up the possibility for health plans and pharmacy benefit management companies to include them in their formularies. This would allow patients to access these treatments through their local retail pharmacies.

However, the safety and efficacy of these drugs will need to be thoroughly studied and documented to ensure they’re appropriate for use in an outpatient setting. Additionally, there are logistical challenges associated with storing and dispensing these drugs, as well as training pharmacists and other healthcare professionals to administer them safely.

Five things to consider in the care management process are:

1. Safety: Safety should always be the top priority when utilizing any therapy for mental health and substance use treatment. It’s important to carefully screen and monitor patients, ensure the quality and purity of the psilocybin, and follow established protocols for administering the substance.

2. Dosage: The optimal dosage for psilocybin in treatment is still being studied. It’s important to start with a low dose and carefully titrate the dosage based on the patient’s response and tolerance to minimize potential side effects.

3. Setting: The setting in which psilocybin is administered is crucial to the patient’s experience. The treatment should be conducted in a comfortable, private setting with a trained therapist present to guide the patient through the experience and ensure their safety.

4. Integration: The experience of using psilocybin can be intense and overwhelming for some patients. It’s important to have a structured integration plan in place to help patients make sense of their experience and apply what they learned to their daily lives.

5. Legal considerations: Psilocybin is still a Schedule I drug in the United States, meaning that it is illegal to possess or distribute. Researchers and therapists must adhere to strict regulations and obtain the necessary permits to conduct studies and administer the substance.

The possible integration of psychedelics and outpatient retail pharmacy is exciting, and continued research and consideration of the potential risks and benefits will determine whether these drugs become a mainstream treatment option for people dealing with mental health and substance use issues.