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Letter from CMS Regarding Ketamine

I thought it might be informative to post the letter I received in October 2022, from Daniel Tsai, Deputy Administrator and Director of CMS, regarding racemic ketamine infusions for mental health.


This letter is written in a language I call "official bureaucratese," so all highlighting and text emphasis has been added by me. Different highlight colors are used in order to differentiate segments from one another.


The blue section simply says that racemic ketamine can be used for off-label indications.

The green section shows that use of racemic ketamine in treatment-resistant depression and suicidality does, in fact, meet the federal statutory definition of "medically accepted."

The peach section is self-explanatory.

The purple section needs to be emphasized, as CMS clearly notes the "benefits of covering these drugs..."


Keep in mind that this letter was written to me in October 2022. It is now the end of November 2023. Very few state Medicaid programs are covering these infusions, despite Mr. Tsai stating that "CMS will continue to work with states to help them better understand the benefits of covering these drugs for their beneficiaries to offer multiple treatment options."


And, the bigger question - though not the focus of my post here - is that since CMS wants the states to "understand the benefits of multiple treatment options," why has CMS not promulgated a National Coverage Determination so that Medicare covers these infusions, more than a year after CMS acknowledged the benefits?






















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