Does Medicare Cover Ketamine Infusion Treatments?

Medicare Benefits Solutions
Jan 17, 2023

Ketamine is a non-opioid drug that some healthcare providers recommend for major depression, chronic pain and post-traumatic stress disorder (PTSD). If you have Medicare coverage and are researching depression medications, you may ask, does Medicare cover ketamine infusion treatments? The answer hinges on FDA approval.

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Is Ketamine Covered by Medicare?

Hospitals and military operations have used ketamine as an anesthetic for over 50 years. And, the FDA has approved ketamine hydrochloride for general anesthesia, not for infusion as a depression medication.

Medicare excludes coverage for drugs not approved by the U.S Food and Drug Administration (FDA). The FDA has not approved ketamine to treat any psychiatric disorder. 

TIP: Continue reading to learn about the recent FDA approval of esketamine nasal spray to help manage certain health conditions.

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Ketamine Infusions vs Esketamine Nasal Spray

Treatment-resistant depression is depression that has been non-responsive to at least two drugs. There are two primary kinds of ketamine used to treat this type of depression. One type is called racemic ketamine, a mix of two molecules. The other is esketamine, a derivative of ketamine, which uses only one molecule. 

Spravato is the brand name for esketamine. Racemic ketamine is usually administered as an infusion whereas Spravato is a nasal spray. Esketamine is not the same drug as ketamine. The two drugs differ in terms of delivery, risks, effectiveness and side effects. The FDA has not approved a ketamine nasal spray. 

The FDA has approved nasal spray esketamine, under the brand name Spravato, for the treatment of major depressive disorder or suicidal ideation in certain circumstances. If your doctor has prescribed Spravato, it may be covered under Medicare Part B. Part B is responsible for covering this drug because it must be administered by a medical provider. Your doctor may have to document that other methods of treatment, such as antidepressants, were ineffective in treating your condition. 

Does Medicare Cover Sparvato?

In 2019, the FDA approved esketamine as a nasal spray to help adults with treatment-resistant depression and major depressive disorder with suicidal tendencies. If you have Medicare coverage, you may have help paying for Spravato. 

The FDA imposes strict rules on how Spravato is dispensed and administered. The medication must be delivered in a healthcare facility that holds a certification in a safety program known as Risk Evaluation and Mitigation Strategy (REMS). Patients are not released until they have been monitored for at least two hours after the drug is administered.  

What is Ketamine Infusion for Depression?

When a healthcare technician uses an intravenous (IV) approach to deliver your medications, the tech may deliver the drug into your veins through injection or infusion. IV injections make it possible for drugs to enter your system quickly. 

Infusions can last a few minutes, several hours or more than one day, enabling the medication to work through your system for a long duration. Some people report relief from depression within one to three ketamine infusions. 

How Does Ketamine Affect Your Brain?

A synapse is a space that lies in-between nerve cells. Synaptogenesis is a process whereby a neurotransmitter triggers the release of molecules that promote communication between nerve cells. 

This process can have a favorable effect on your state of mind and perception. One theory is that ketamine elevates mood by increasing the level of these neurotransmitters. This is in contrast to traditional antidepressants that work by increasing the levels of serotonin, a hormone known to play a key role in mood.

Does Medicare Advantage Cover Ketamine Treatment?

Medicare Advantage (MA) is an alternative to Original Medicare Parts A and B. MA plans are required to include the same Part A and Part B coverage as Original Medicare, but most plans include prescription drug benefits, along with other additional benefits.  If you have an MA plan with prescription drug coverage, referred to as an MA-PD plan, check the plan’s formulary to identify the medications your plan approves.

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