Dear Health Insurance Company Representative,
Thank you for being a part of the system that helps to reduce the cost of health care for me and my patients. I appreciate your commitment to collaborating and serving patients by covering the charges from unexpected healthcare fees. Because of your services it allows for greater coverage to a large group of people for disease prevention, improving health, and fully living life.
As the Founder and Medical Director of Reset Ketamine, I wanted to share with you some information about the “off-label” use of ketamine for treatment-resistant depression (TRD). Ketamine is a generic FDA approved drug for use in diagnostic and surgical procedures. It has been used safely in humans for over 50 years in the ER and the OR. The World Health Organization (WHO) lists ketamine in its “List of Essential Medicines.”
Now, a small group of providers are using ketamine for “off-label” treatments that can potentially benefit your patients tremendously and save your company money at the same time.
As you are probably aware, we are facing an epidemic in depression, anxiety, and suicide. More people in the United States feel anxious and depressed now more than ever. According to the CDC, we are reaching peaks in suicide rates, which has increased 33% between the years of 1999 and 2017.
The current options that are covered for treatment-resistant depression (TRD) is transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). The cost of TMS can be up to $15,000 and the cost of inpatient ECT can run up to $25,000, which does not include the cost of inpatient hospital admission. Furthemore, both TMS and ECT treatments require booster treatments after the initial treatment. Ketamine infusions costs will be significantly less for your company than TMS or ECT.
Your patients are seeking and requesting coverage of these ketamine infusion treatments.
To review the scientific evidence, the first randomized double blinded controlled trial was done in 2000. Since the initial study, multiple trials have confirmed that ketamine can be rapidly effective in TRD with sustained effects. A recent meta analysis pooled the data from multiple trials and concludes, “Ketamine has shown promise in quickly reducing symptoms in patients with treatment resistant depression and bipolar depression. Using ketamine may be helpful for patients that have exhausted other therapeutic options.”
I understand that one of the limitations is that there are no major long term studies following patients. Realistically, we know this will be challenging to perform due to limited research funding for generic drugs. In addition, to get FDA approval for ketamine for another indication will not happen since no pharmaceutical company would have a financial incentive to fund research on an off-patent medicine.
I respectfully urge you to consider adding insurance coverage for ketamine infusions to better serve your patients by pre-approving treatments and reimbursing patients who have already paid out of pocket for these treatments.
Thank you for your attention to this important matter.
H. Samuel Ko, MD, MBA, FACEP