Health Plan Provider Enthea Will Cover Ketamine- and Psilocybin-Assisted Therapy

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Ketamine, a well-known anesthetic, is emerging as a promising treatment for various mental health conditions, including depression and post-traumatic stress disorder (PTSD). Its potential benefits have prompted some companies to consider offering psilocybin- and ketamine-assisted therapy (KAT) as an employee benefit.

Dr. Bronner’s, a prominent soap manufacturer, became one of the first companies to provide KAT as an employee benefit, partnering with Enthea, a third-party administrator specializing in medication-assisted therapies. Enthea’s co-founder and CEO, Sherry Rais, shared that the company currently has 10 customers offering KAT and another 50 with signed letters of intent.

Employers are drawn to KAT’s potential to improve employee mental health and well-being, potentially leading to increased employee retention. Rais highlighted that a full course of ketamine treatment typically costs between $6,000 to $8,000, and companies may spend between $35 to $200 per employee annually to cover it.

However, HR departments should exercise caution when considering KAT as an employee benefit. The FDA has issued an alert regarding the potential risks associated with compounded ketamine products and the importance of healthcare provider monitoring. Additionally, Stat News reported inconsistencies among ketamine clinics in terms of patient screening, dosage, and therapy integration.

To address these concerns, Enthea meticulously vets its partner clinics, ensuring they are licensed to administer ketamine and have undergone a thorough credentialing process. They also review training backgrounds, practice experience, and therapy incorporation before partnering with any providers.

While currently illegal at the federal level, psychedelics like MDMA and psilocybin are undergoing clinical trials for various mental health conditions, showing promising results. Rais anticipates their rescheduling within the next two years, paving the way for legal treatment options.

Despite Enthea’s efforts to make these therapies more accessible, traditional health insurance companies are generally not covering psychedelics. However, esketamine, a ketamine derivative approved by the FDA for treatment-resistant depression, is often covered with prior approval due to its high cost.

As research on ketamine’s therapeutic potential continues to expand, experts like Jeff Levin-Scherz, a population health leader at WTW, believe traditional health insurers may become more receptive to covering ketamine-based treatments.

In conclusion, ketamine is emerging as a promising treatment for various mental health conditions, prompting companies to consider offering KAT as an employee benefit. However, HR departments should carefully evaluate the risks and ensure providers adhere to strict guidelines. As research progresses and regulatory landscapes evolve, ketamine-based treatments may become more widely accessible.

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