Medicare does not typically cover ketamine infusions for mental health conditions. However, it may cover Spravato, an FDA-approved drug deriving from ketamine, for treatment-resistant depression.
Currently, the Food and Drug Administration (FDA) only approves ketamine for use as a general anesthetic. Although research suggests the drug has significant potential as a treatment for mental health conditions, including treatment-resistant depression and suicidal ideation, these approaches are awaiting FDA approval.
Because it is still awaiting approval, Medicare does not typically cover the use of ketamine infusion for treating mental health conditions. However, they may cover the FDA-approved nasal spray, Spravato, which contains a derivative of ketamine called esketamine.
This article examines Medicare coverage for ketamine infusion, coverage for Spravato, and alternate coverage options. It also explains how to access ketamine therapy. Does Medicare cover ketamine infusions?
Close up of an IV drip mid infusion Original Medicare covers infusions that a healthcare professional administers. However, it does not generally cover ketamine infusions for mental health conditions such as depression and anxiety .
Part B may not cover ketamine infusions for mental health conditions due to the following reasons: Off-label use
Off-label use is when a doctor prescribes a drug for non-FDA-approved uses. It is legal for doctors to prescribe and administer a drug for off-label use if they judge it to be medically appropriate.
Doctors use ketamine off-label to treat several conditions, including pain, treatment-resistant depression , and suicidal ideation .
However, Medicare Part B generally prohibits off-label uses unless one of two specific drug information authorities — the DRUGDEX Information System and the American Hospital Formulary Service Drug Information — support them.These authorities do not support ketamine infusions as a mental health treatment, which is why there is no coverage for this approach. Non-FDA approved status Although research suggests ketamine is a promising treatment for several mental health conditions, the FDA has not yet approved the drug for these uses.More large-scale clinical trials are necessary to gain FDA approval, but these are often extensive and can take several years .Currently, the FDA warns of the following: The organization has not determined ketamine to be a safe […]
Does Medicare cover ketamine infusions for mental health conditions?
