Costs by ROA/Location

The costs of ketamine therapy for mental health treatment vary depending on the following:

• the ROA (route of administration),
• location (in-clinic / at-home),
• provider pricing policy, and
• bundled psychotherapy/integration services.

Below are descriptions of pricing by ROA. These are our generalizations of the examples enumerated in the table below. Bear in mind that these are illustrative. You must consult each provider for current rates and packages of services vs. per-service pricing. We do not undertake to provide pricing information for many providers, let alone all providers we list in our directories. Our intention here is modest. To give you some idea of what some providers are charging so you have some benchmark to evaluate providers you short-list in your search for your own provider. Where does your candidate provider fit within the price ranges listed in our illustrations?

It’s especially important to understand that each patient’s course of initial treatment and ongoing maintenance is individual to that patient’s progress and durability. Your course of treatment will probably be:

– longer and more frequent with at-home ROAs, and,

– shorter with in-clinic ROAs.

For a given patient, one tele-ketamine provider might recommend a more extended maintenance period, another a shorter maintenance period—likewise, one in-clinic provider more frequent boosters, another less frequent boosters. There is no way for us to account for such variations. So, we have assumed a normalized example of 12 administrations for the in-clinic providers.

1. Intravenous (IV) infusion: Most in-clinic pricing is for IV. Monthly pricing, annualized for a single year, seems clustered around $300 -$450 – $550. A few are below $300, and a couple are above $550. Most are around $450. IV providers often price an initial “package” of 4-6-8 initial sessions with additional maintenance sessions as needed. Initial “boosters” are more frequently spaced; later boosters are less frequently spaced. The number of boosters a patient requires in the 2nd and subsequent years is highly individualistic. Maybe none; maybe just one or two boosters. The frequency of boosters in the third and following years seems to drop dramatically. Because the IV ROA seems to be more durable than the SL/PR/PV ROAs, the lifetime cost of ketamine IV might be lower than the lifetime cost of other ROAs. And if this is the case for an individual patient, then, in fact, the in-clinic IV ROA might prove to be more economical than the at-home ROAs. In-clinic ketamine is rarely (if ever) priced separately for the clinical services vs. the drug cost. You pay for each administration – or a “six-pack” of administrations. Cost is heavily front-loaded for IV.
2. Intramuscular (IM) injection: IM ketamine injections cost $50 to $100 less per treatment than IV, albeit we currently have much less information on IM provider pricing. As with IV, a typical course of treatment is six or more closely spaced injections followed by six or more less-frequent injections in the first year. And, likely, maintenance injections in the 2nd year, perhaps more frequent than IVs. A given patient might get 3 IV boosters in the second year but 4 IM boosters in the second year. Because IM therapy seems to be a little less durable than IV therapy, the slight price advantage per administration of IM over IV could be illusory. If a patient needs a couple more IM injections than that same patient would have needed had he chosen IV infusions, then the price advantage of IM vs. IV administrations is probably negligible, or the IM ROA could be a little more expensive than the IV ROA. Moreover, the cost and inconvenience of more trips to the clinic in the first couple of years could tip the balance of advantage toward IV. As with IV, pricing is per administration or six-pack and is front-loaded.
3. Subcutaneous (SC) injection: We have no information on the costs of subcutaneous ketamine injections. We presume they would be similar to IM injection costs.
4. Transdermal: We have no information on the costs of transdermal products and provider services. These are either still in development or not widely distributed, so they are apt to be high when initially brought to market.
5. Nasal / Sublingual / Rectal / Vaginal (SL/PR/PV): Usually, but not always, tele-ketamine providers send your prescription to a compounding pharmacy to be dispensed. You pay the doctor for his consultation and the pharmacy for the ketamine shipped to your home. Ketamine lozenges, suppositories, and sprays are prescribed and dispensed monthly. After the first year, your prescriber may give you a prescription for 2 or 3 months. The DEA limit is six months, but a physician rarely prescribes a supply sufficient for more than three months. Ketamine lozenges (torches or Rapidly Dissolving Tablets) are priced – for a one-month supply – from a low of $50 to higher prices of $100 or $150, occasionally a little higher. Your taste in flavor or level of service might justify paying up to $100/month to a preferred pharmacy. We don’t see why one would pay much over $100/month. A supply sufficient for multiple months may be slightly lower per month than the cost of several single months’ supplies. (E.g., a pharmacy that charges you $50/month might charge you $130 for a single shipment of a 3-month supply.) Ketamine in nasal spray or suppository form is likely more expensive than lozenges. We don’t have enough information to quote a price differential. The wholesale cost of ketamine is so low ($250/kg) that the cost of the ketamine in each lozenge/suppository/spray is a negligible component of the total cost. Therefore, doses of 400 mg are typically no more expensive than 100 mg from the same pharmacy. The cost of compounding bulk ketamine into lozenges/suppositories/sprays is so low that a month’s supply of 15 or 30 doses is typically no more than a month’s supply of 5 or 10 from the same pharmacy. Most of the cost of tele-ketamine is in the consultation services the prescriber provides. These range from about $250 at the lower end to $350 at the higher end. Notable exceptions are Joyous and Mindbloom. Joyous is the low-price / low-service leader in tele-ketamine. Mindbloom is the high-price / high-service pace-setter in tele-ketamine. Some patients are so economically challenged that they may barely afford Joyous. And Joyous has a 3-month financial assistance price of just $89/month. Some patients will find that the highest-priced providers are economical because their bundled ketamine and ketamine-assisted psychotherapy services cost less than buying psychotherapy independently.
6. Nebulization: We have no information on the costs of ketamine formulations suitable for the nebulization ROA.
7. Spravato Nasal spray: Esketamine (trade-mark Spravato) is only distributed as a nasal spray formulation. It was patented by the Janssen subsidiary of Johnson & Johnson and approved by the FDA in 2019 for TRD treatment-resistant depression. The FDA imposed a REMS Risk Evaluation and Mitigation Strategy such that a licensed physician can only administer Spravato in a licensed clinic. So, the twin facts that: Spravato is a patented drug, and, that it can only be administered in-clinic make the esketamine (Spravato) form of ketamine expensive, perhaps the most expensive means of ketamine therapy. The cost of Spravato can range from $590 to $885 per session, depending on the dose. This cost does not include the associated medical supervision and monitoring required during administration.

Please note that insurance coverage for ketamine therapy varies; most providers do not accept insurance for ketamine, either in the clinic or via tele-ketamine. It is essential to consult with individual providers and your insurance company to determine the actual costs and coverage.

The cost-evaluation of ketamine therapy is complicated by the following:

• availability, cost, and convenience of transportation to a clinic, vs
• convenience, zero cost, and familiarity with at-home administration
• confidence/comfort of being in a medical environment vs
• confidence/comfort of being at home in a familiar environment
• ancillary integration/psychotherapy services covered by some providers
• the durability of IV/IM vs. apparently less durable Nasal/SL/PR/PV ROAs
• the desirability of reducing cystitis risk by high bioavailability of IV/IM ROAs

Wilkinson, S. T., & Sanacora, G. (2019). A New Generation of Antidepressants: An Update on the Pharmaceutical Pipeline for Novel and Rapid-Acting Therapeutics in Mood Disorders Based on Glutamate/GABA Neurotransmitter Systems. Drug Discovery Today, 24(2), 606-615. Retrieved from https://www.sciencedirect.com/science/article/pii/S1359644618306935

Cost Estimate for Ketamine Therapy. Ketamine Clinics Directory. Retrieved from https://www .ketamineclinicsdirectory.com/cost-of-ketamine-therapy/

Spravato (esketamine) [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; 2019. Retrieved from https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf