Nushama and Curated have payment arrangements for patients who are unable to afford their services, but they're trying creative approaches to lower barriers further.
"Psychedelic treatment should not be reserved only for the rarefied few who can afford it," Meloff said.
Ketamine therapy is typically a one-on-one setting, including its infusion and integration—where a therapist provides counseling support afterward. Nushama is exploring group settings for both components.
Using one room for six to eight people rather than for one person provides operational savings, which can be passed on to the patient, Meloff said. More staffing will be required in a group infusion setting, but not equivalently more, he said.
"A two-hour treatment remains a two-hour treatment, even if more people are in the room," he explained. Special care will be needed to set up a room that ensures an effective and safe infusion session in a group setting, he added.
Curated is exploring group settings for just the integration component. The model is similar to group therapy that exists already. Group settings might achieve cost savings for patients using self-pay, or for those who have not yet met their deductible on their insurance, Itzkoff said. For those with a standard co-pay or who have all costs fully covered by insurance, however, they would likely not see any difference in out-of-pocket costs, she said.
Both Meloff and Itzkoff said that group integration was being considered beyond just cost considerations. Group therapy can be highly effective for people with shared experiences or trauma, they said.
As part of Curated's efforts to explore group settings, it partnered with Brooklyn Minds Psychiatry, with locations in Midtown and Williamsburg, on April 19. Brooklyn Minds has an expertise in group therapy and has providers credentialed by commercial payers, Medicaid and Medicare. By partnering, ketamine and therapy services can be available at both organizations' locations, along with shared resources for back-end processing and administration, Itzkoff said.
While it is a struggle to make even ketamine accessible, setting the stage is important for when other promising psychedelic compounds, such as psilocybin or MDMA, become accepted as treatment, Meloff said, adding those forms of therapies can have similar protocols with ketamine.
"We've already started designing our spaces in mind for both MDMA and psilocybin," Itzkoff said. There are specific hurdles unique to those compounds—psilocybin therapy can last up to eight hours and there are city zoning restrictions to how long a patient can be kept on-site, she explained.
"Our challenges will be similar [with ketamine's], but I believe if we gain ground now with payers and the city, we will be in a good position to make those arguments for those treatments in the future," Itzkoff said.
This story first appeared in our sister publication, Crain's New York Business.