Is Ketamine Treatment Covered by Insurance in Ontario?

Ketamine therapy is becoming a popular choice for those exploring non-traditional treatments for mental health disorders. A common concern for prospective patients is whether ketamine assisted psychotherapy is covered by health insurance in Ontario. Currently, ketamine infusion therapy is not covered by any insurance plan in Canada.

Challenges in providing coverage for Ketamine Therapy

Ketamine is an increasingly popular medication for severe depression that is resistant to other forms of treatment. However, legal use of ketamine for therapeutic treatment in Canada is relatively new. Most ketamine therapy for treatment resistant depression is still considered an “off-label” use of ketamine by Health Canada.

Generally, private medical insurance companies will not cover “off-label” use of ketamine, even in therapeutic settings. However, most insurers do cover the prescription costs of Esketamine. Additionally, private medical insurance will often cover other parts of your treatment, such as psychotherapy sessions and medical evaluations. So, it is best to check with your insurer when considering ketamine treatment to see what may be covered, and how the elements of your treatment plan can be billed to maximize your insurance coverage options.

As ketamine therapy becomes more widely used in mental health care, there is a need for clear policies and insurance support structures for patients. Until this is available, good communication and cooperation between healthcare providers, insurance, and patients is needed to ensure maximum coverage for your ketamine-assisted therapy.

Does OHIP Cover Ketamine Treatment?

Ontario Health Insurance Plan (OHIP) does not provide coverage for ketamine-assisted therapy at this time. Like many public health insurance systems, OHIP covers only approved therapies for chronic pain . Currently, OHIP does not cover depression-related ketamine use, because it is considered an “off-label” use by Health Canada.

OHIP will cover visits to your physician or psychiatrist who can refer you to a reputable provider of ketamine-assisted therapy. When referred by a physician, your initial intake consultation is covered by OHIP as well.

Will ketamine-therapy be covered in the future? Should I wait?

Recently Health Canada approved a nasal-spray version of ketamine, which may start to be covered by third-party medical insurance soon. However, intravenous and lozenge forms of ketamine, which are most commonly used in supervised ketamine-assisted therapy, are still not approved by Health Canada for the use in treatment-resistant depression. Therefore, it is unlikely your medical insurance will automatically cover these costs. Before starting therapy, we recommend speaking to your insurance provider about your coverage options.

Since it may take several years for insurance companies to update their standard policies to include this new treatment approach, we do not recommend that you delay your treatment. Please contact us if you have questions about payment options for your treatment.

Caledon Clinic remains at the forefront of these changes, committed to offering up-to-date information and guidance to those seeking mental health treatment. Contact us today to decide if ketamine-assisted therapy is the right treatment option for you.