April 1, 2023

Why Ketamine is SO expensive (pharma hacks)

Dr. Kaveh explains me-too drugs, look-alike drugs, and patient extenders, and how they keep medications so expensive, like ketamine and esketamine

Have you been "stuck" with depression, anxiety, or chronic pain? Were you excited to hear about the power of ketamine to help heal... just to find out that insurance doesn't cover it? Learn the dirty secrets behind what's keeping ketamine so expensive.

Here's an outline of what we'll be discussing:

Depression affects millions of people around the world, yet finding the right treatment can often be a difficult and frustrating process. For years, the go-to treatments for depression have been traditional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). However, these medications can take weeks or even months to take effect, and many people find that they simply don't work for them. Fortunately, there's a different kind of antidepressant that's gaining popularity: ketamine.

Ketamine therapy involves the use of a dissociative anesthetic that has been shown to have rapid and potent antidepressant effects. Unlike traditional antidepressants, ketamine works on different receptors in the brain and can take effect in a matter of hours or even minutes. Ketamine therapy can be administered through a variety of delivery routes, including intravenous (IV) infusion, intranasal spray, and oral tablets.

One of the biggest barriers to accessing ketamine therapy, however, is the cost. Ketamine therapy is still considered an "off-label" use of the drug, meaning it's not officially approved by the FDA for the treatment of depression. As a result, many insurance companies won't cover the cost of ketamine therapy, leaving patients to pay out of pocket. This is a significant issue for many people, especially those who have been struggling with depression for years and have already tried multiple other treatments without success.

Another issue that has slowed the adoption of ketamine therapy is the lack of research on the drug. Despite numerous studies showing its effectiveness, there hasn't been as much research into ketamine therapy as required for the expensive FDA approval process. This is largely due to patent law. In reality, it's far more lucrative to produce medications as patent extenders, which are minor modifications to the drug that allow pharmaceutical companies to extend their patents and continue profiting from these "me-too" drugs. This has resulted in a lack of interest from big pharma in conducting further research on ketamine therapy, as it's no longer a lucrative market for them. Instead, ESketamine has been researched further because of the ability to patent it and generate greater profit from it versus generic, racemic ketamine. We'll explain all this in the video

The original FDA approval for ketamine was in the 1970s as an anesthetic. However, over the past decade, there has been a surge of interest in its use as an off-label drug for the treatment of depression. Despite this surge of interest, there hasn't been much incentive for pharmaceutical companies to conduct research into the drug's efficacy in treating depression. The lack of research, combined with the high cost of ketamine therapy, has made it difficult for many people to access this potentially life-saving treatment.

Another issue that has contributed to the slow adoption of ketamine therapy is the lack of insurance coverage for "holistic" therapies like ketamine. Insurance companies are often hesitant to cover the cost of alternative therapies, as they aren't always backed by the same level of scientific evidence as traditional treatments. This has led many patients to pay out of pocket for ketamine therapy, which can be prohibitively expensive for many people.

Despite these obstacles, there are still ways to access ketamine therapy. One option is to look for generics, which can be more affordable than brand-name versions of the drug. However, the supply of generics can be limited due to the lack of research and interest from pharmaceutical companies. Additionally, some generics may be "look-alike" drugs that aren't actually the same as the brand-name drug.

The delivery route for ketamine therapy can also have an impact on its effectiveness. IV ketamine infusion therapy, which is administered in a clinical setting, is considered the most effective delivery method. However, it can also be the most expensive, and some people may not be comfortable with the idea of undergoing an infusion in a clinical setting. Intranasal spray and oral tablets are alternative delivery methods that can be more convenient and affordable, but they may not be as effective as IV infusion therapy.

Despite the challenges, many people who have tried ketamine therapy for depression have reported significant improvements in their symptoms. Ketamine therapy can offer a glimmer of hope for those who have been struggling with depression for years and have not found relief with traditional antidepressants. However, it's important to note that ketamine therapy is not a panacea, and it must be used in an integrated, holistic manner. It's also important to work with an experienced healthcare provider who can guide you through the process and monitor your progress.

In conclusion, ketamine therapy is a promising new treatment for depression that offers rapid and potent relief for many people. However, the high cost and lack of insurance coverage have made it difficult for many people to access this potentially life-changing treatment. While there are challenges to accessing ketamine therapy, there are still ways to obtain it. As research into ketamine therapy continues, it's important to remain hopeful about the future of mental health treatment and to continue advocating for access to effective therapies for those who need them.

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