The $$Cost$$ of Fighting for Your Life
Ketamine was approved in 1970 by the FDA for use as an anesthesia and for pain management. It is a psychedelic, and like all psychedelics, Ketamine has shown substantial benefit in the treatment of drug resistant depression. However, if a drug is not approved by the FDA for treatment of a specific diagnosis, it is not covered by insurance for that diagnosis, any use of that drug for a non approved condition is considered "off-label use".
Because Ketamine has been around so long and is no longer under patent, there is no financial incentive for pharmaceutical companies to initiate clinical studies to add drug resistant depression as an FDA approved diagnosis for its use. So, no covered diagnosis, no covered treatment. But if you have lots of money, you can pay for it yourself! Ketamine infusion clinics have proliferated around the country to service wealthy patients with drug resistant depression.
The Ketamine clinic in Tacoma I researched charged $1000 a treatment, four times the first month, every other week the second month, then monthly thereafter. So $4000 month one, $2000 month two, and $1000 a month indefinitely. All cash out of pocket, paid up front.
The Ketamine IV infusion method is expensive, since the patient requires medical supervision during the roughly 40 minute infusion. However, Ketamine can be administered in different, less expensive forms, including intramuscular injections and lozenges.
Drugs.com lists the price of Ketamine 100 mg injectable solution at $73.03. A standard intramuscular dosage is 0.5 mg. (Gosh I hope my math is right here, because math is not my thing. If I'm wrong, tell me... ) Therefore, 100 mg is 200 doses, making the cost per dose 37 cents, plus the cost of administration by a medical professional. One person I connected with online told me his doctor prescribes the medication, he purchases it at the pharmacy, and self administers his injections. So his cost is 37 cents plus the cost of a syringe and needle.
Ketamine lozenges are called "troches". And my brain is mathed out (ya, it doesn't take much), so I'll price that out later.
The bottom line is, although Ketamine infusions are the established and preferred method of administration, intramuscular injection and troches are far far less expensive and are proven effective. How effective? Just as effective? Well. Since there's no profit potential in Ketamine, no one is lining up to fund any clinical trials, so it's unknown at this time.
The good news is, in order to rape the majority of people of modest means that suffer from drug resistant depression, and cannot afford to pay out of pocket for Ketamine infusions, Janssen Pharmaceuticals developed Spravato, which is administered via a nasal spray.
Spravato is an extremely, and I mean extremely slight molecular variation on Ketamine, and therefore can be patented and sold at an obscenely unethical amount per dosage. According to the GoodRX.com site, the average retail cost of Spravato 84 mg, per single dose is $1446. With a Good RX coupon, the drug can be purchased retail for $1114.
I was recently approved for Spravato treatment through Medicare. However after pricing it out, the out of pocket cost AFTER INSURANCE is prohibitive so I will not be able to proceed.
I'm sharing this information to showcase the fact that even after insurance pays, people that suffer as I do are generally unable to receive this lifesaving treatment.
Most pharmaceutical companies have charity assistance programs that help offset the cost of patented drugs for people that meet specific criteria.
Although I am on SSDI, because I was a high wage earner for many years, I make about two times what most people receive on SSDI, and I am just a bit above two times the poverty level in Washington State, making me ineligible for any income-based programs.
Furthermore, since I am on Medicare, a "government sponsored insurance", I am automatically ruled out from the Janssen Carepath Savings Program. The immediate rule out based on my Medicare coverage makes the fact the treatment is cost prohibitive in relation to my SSDI income inconsequential.
I put together Exhibit A to include with a series of letters I am sending to the NIH and the Janssen Carepath Savings Program. I am gathering information for freelance articles and to further support my advocacy activities. I'm keeping my State senators and representative apprised of all my activities and I am copying them on all correspondence.
EXHIBIT A BREAKDOWN OF MY OUT-OF-POCKET COSTS FOR SPRAVATO TREATMENT
This is the breakdown of my out-of-pocket costs of Spravato treatment AFTER Medicare.
Spravato is a non-formulary drug, it is defined as a “Tier 4” drug. I have a $260 annual deductible for Tier 4 drugs which has not been figured into any of the calculations that follow.
The protocol for treatment is as follows:
Two times a week for four weeks. (8)
One time a week for four weeks. (4)
Every other week for two months. (4)
For a total of 16 treatments.
The out-of-pocket (co-insurance) for each office visit for administration of the drug is $56.40. This co-insurance remains constant and is based on the standard fee schedule allowance for my region. Therefore, the total costs of the office visit for Spravato administration is $902.40. (16 x $56.40).
The first Spravato dosage is 56 mg, of which my out-of-pocket (co-insurance) is $215.30. This co-insurance remains constant and is based on the standard fee schedule allowance for my region.
All subsequent 15 Spravato dosages are 84 mg, of which my out-of-pocket (co-insurance) is $362.58. This co-insurance remains constant and is based on the standard fee schedule allowance for my region.
Therefore, the total out-of-pocket cost of Spravato alone is: $5654.00. ($215.30 + (15 x $362.58)).
The total treatment cost, office visit/admin visits + Spravato is $6556.40. ($5654.00 + $902.40)
The total treatment cost, office visit/admin visits + Spravato, is 23% of my net SSDI income.
The treatment cost of just the Spravato is 20% of my net SSDI income.