A woman demonstrates what a patient would experience at a psychedelic therapy clinic in Toronto. Photographer: Cole Burston/AFP
Having a health insurer pay for a magic-mushroom trip or an ecstasy experience might sound far-fetched, but the psychedelics industry is already running the numbers and pitching US insurers.
Optimism was high at last week’s Horizons: Perspectives on Psychedelics conference in New York. With good reason: Clinical trials on drugs like psilocybin and MDMA have shown promise in their early stages. While they’re still ongoing, many take aim at some of the most difficult-to-treat and expensive mental-health ailments in the midst of what’s widely decried as a mental-health crisis. During the conference’s business forum, researchers and executives talked about how that may persuade health insurers, or “payors,” to get onboard.
“Every payor is looking for mental-health solutions,” said Michael Mullette, chief operations officer at the public benefit corporation of MAPS, or Multidisciplinary Association for Psychedelic Studies.
Mental-health spending in the US is estimated to be more than $200 billion a year, with a lot coming from the US Medicaid program. Private insurers also spend a lot on treatments such as antidepressants — mostly selective serotonin reuptake inhibitors, or SSRIs, which are prescribed for ailments including PTSD, anxiety and depression. Many reimburse patients for talk therapy, which can be effective, but is a costly and slow process of healing.
Psychedelics are being researched as an alternative to SSRIs, mostly in conjunction with so-called “psychedelic-assisted therapy,” where the drugs are thought to make patients more receptive to mental change. While no such treatments have been approved yet, it’s expected that they will be expensive, given some psychedelics often involve hours-long experiences that need to be monitored by “trip sitters,” and counseling would come on top of that. Getting insurers onboard is therefore critical for the widespread use that psychedelics startups are aiming for.
There are some major caveats, of course. And even if regulators approve the treatments, providers of psychedelic therapies will have to show they are cost effective.
MAPS’s research on MDMA — also known as ecstasy or Molly in its street incarnations — to treat post-traumatic stress disorder is seen as something of a leading indicator. Its clinical trials of MDMA for PTSD are already in advanced stages, positioning MDMA to potentially be the first psychedelic drug to be commercialized if the US Food and Drug Administration gives a greenlight. But it will face an interesting challenge since drug-assisted therapy is a novel model for both the FDA and insurers. Mullette, who joined MAPS in March, has some interesting background in bringing novel treatments to market and working with insurance firms: As a vice president at Moderna, he helped roll out Covid-19 vaccines at the height of the pandemic
“They are extremely encouraged by our data,” Mullette said of his organization’s approaches to insurers so far, without sharing details of who MAPS may have shared data with.
Indeed, the data look promising, according to a separate presentation at the conference from Elliot Marseille, the course director for cost-effectiveness analysis in medicine and public health at the University of California in San Francisco. Now a consultant for MAPS, Marseille has done research in the past about cost-effective remedies for HIV and AIDS.
Published: October 17, 2022
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