Psychedelics As An Employee Benefit? (with Amil Patel)

This video features Amil Patel, co-founder and CEO of Meeko Health, who discusses the critical need for innovative mental health solutions and advocates for the integration of psychedelic therapies, specifically ketamine, as an employee benefit. The conversation, hosted by Spencer on the "Self-Funded" podcast, explores the profound impact of childhood experiences on adult mental health, the shortcomings of traditional psychiatric approaches, and the emerging landscape of psychedelic medicine. Patel shares his personal journey with MDMA therapy as a catalyst for his mission to expand access to these treatments, highlighting their potential for durable healing by addressing root causes rather than just symptoms.

The discussion delves into the regulatory and market dynamics surrounding psychedelic therapies. Patel explains that while ketamine is FDA-approved as an anesthetic, its off-label use for mental health conditions like depression, anxiety, and PTSD is widespread, legal, and supported by significant safety and efficacy data. He contrasts generic ketamine with branded Spravato (esketamine), emphasizing the substantial cost difference and access barriers associated with the latter. The podcast also touches upon the impending FDA decision for MDMA therapy (expected August 2024, sponsored by Lykos Therapeutics/MAPS) and the progress of psilocybin in clinical trials (Compass Pathways), signaling a broader cultural and medical shift towards these treatments.

Patel outlines Meeko Health's model, which involves carving out psychedelic support benefits for employers, allowing both self-funded and fully insured companies to offer access to vetted networks of providers. He draws parallels to the evolution of fertility benefits, suggesting a similar path for destigmatizing and integrating psychedelic therapies into mainstream healthcare. The speakers also critically examine the societal implications of the "War on Drugs" versus the opioid crisis, arguing for greater personal agency in health decisions and a re-evaluation of what constitutes safe and effective treatment. Ultimately, the conversation paints a picture of a future where mental health care is psychology-driven, focused on healing trauma, and leads to a more empathetic and healthier society.

Key Takeaways:

• Addressing the Mental Health Crisis: The United States faces a severe mental health crisis, particularly among its workforce and youth, necessitating "radical solutions" beyond existing, often symptom-focused, treatment protocols.
• Psychedelic Therapy as an Innovative Benefit: Ketamine therapy is presented as a safe, efficacious, and innovative mental health benefit that employers can offer to address depression, anxiety, and PTSD, providing a durable solution by targeting root causes.
• Meeko Health's Access Model: Meeko Health facilitates employer-sponsored access to ketamine therapy by carving out a "psychedelic support benefit," integrating it alongside existing health plans for both self-funded and fully insured employers.
• Evolving Regulatory Landscape: MDMA therapy is on the cusp of FDA approval (decision expected August 2024), and psilocybin is in advanced clinical trials, indicating a significant shift towards mainstream acceptance and availability of psychedelic medicines.
• Legality and Prevalence of Off-Label Use: Ketamine is federally legal as an anesthetic, and its off-label prescription for mental health conditions is common and legal, with strong evidence supporting its safety and efficacy.
• Cost-Effectiveness and Accessibility: Generic ketamine therapy is significantly more affordable (e.g., $3,000 for a typical 6-session bundle) compared to branded alternatives like Spravato (esketamine), which can cost over $80,000 annually and faces access barriers from PBMs.
• Shift to a Psychology-Driven Approach: The conversation advocates for moving from a "psychiatry-driven" model (treating mental health as a chronic disease with indefinite medication) to a "psychology-driven" approach (viewing it as an "injury" that can be healed by exploring and resolving underlying trauma).
• Durability of Treatment Outcomes: Psychedelic therapies, particularly ketamine, aim to provide durable relief by enabling individuals to address the root causes of their mental health challenges, reducing the need for continuous, symptom-management treatments.
• Overcoming Stigma through Education and Testimonials: Employers and benefits consultants require education and compelling testimonials from individuals who have experienced the transformative effects of these therapies to overcome the existing stigma surrounding psychedelics.
• Impact of Adverse Childhood Experiences (ACE Study): The ACE study objectively demonstrates that adverse childhood experiences are the number one leading indicator of adult mental health issues, underscoring the importance of addressing early-life trauma.
• Personal Agency in Healthcare Decisions: A growing distrust in traditional regulatory bodies (due to issues like the opioid crisis) is fueling a demand for greater personal agency and choice in health treatments, including novel therapies.
• Potential for Broader Societal Transformation: Widespread access to effective mental health treatments could lead to a more empathetic, physically healthier society, with potential reductions in substance abuse, suicide rates, and improved overall well-being.
• Importance of Individualized Care: Psychedelic therapy, including ketamine, emphasizes an individualized approach tailored to the member's specific needs to achieve relief and healing.

Tools/Resources Mentioned:

• Meeko Health: Company focused on expanding access to psychedelic therapy.
• Paro Health: Benefits captive, sponsor of the podcast.
• Claim.do: Medical claim auditing and member advocacy company, sponsor of the podcast.
• Plansight: End-to-end RFP solution for benefits agencies, sponsor of the podcast.
• Alto Pharmacy: Previous employer of Amil Patel, experience with fertility benefits.
• Progyny: Fertility benefits company, mentioned as a partnership example.
• Lykos Therapeutics / MAPS: Sponsoring MDMA therapy clinical trials.
• Compass Pathways: Publicly traded company sponsoring psilocybin clinical trials (Comp 360).
• MindMed: Sponsoring LSD analog trials for general anxiety disorder.
• ACE Study (Adverse Childhood Experiences): Massive study by Kaiser in California linking childhood trauma to adult mental health issues.

Key Concepts:

• Psychedelic Therapy: A category of therapeutic interventions using psychedelic substances (like ketamine, MDMA, psilocybin) to facilitate mental health treatment, often in conjunction with psychotherapy.
• Ketamine Therapy: Therapeutic use of ketamine, an anesthetic, often off-label, for mental health conditions like depression, anxiety, and PTSD.
• MDMA Therapy: Therapeutic use of MDMA (methylenedioxymethamphetamine), currently in late-stage clinical trials for PTSD, with potential FDA approval.
• Psilocybin Therapy: Therapeutic use of psilocybin (found in "magic mushrooms"), also undergoing clinical trials for various mental health conditions.
• Off-Label Prescribing: Prescribing a medication for a condition or in a manner not specifically approved by the FDA, which is common and legal in the US.
• Self-Funded Benefits: An employer pays directly for employee health claims instead of paying premiums to an insurance company.
• Fully Insured Benefits: An employer pays premiums to an insurance company, which then covers employee health claims.
• PBM Formulary: A list of prescription drugs covered by a pharmacy benefit manager (PBM) for a health plan.
• Personal Agency: The capacity of individuals to make their own free choices and decisions, particularly regarding their health.
• Generational Trauma/Epigenetics: The concept that trauma can be passed down through generations, potentially influencing genetic expression.
• Psychiatry-Driven Approach: A traditional medical model for mental health focusing on diagnosis, symptom management, and often long-term medication.
• Psychology-Driven Approach: An approach to mental health that emphasizes understanding and healing the root causes of distress, often through therapy and introspection, rather than solely managing symptoms.

Examples/Case Studies:

• Amil Patel's Personal MDMA Experience: Amil describes his own transformative MDMA therapy session as the catalyst for his mission, highlighting a deep understanding of his issues and immediate relief after years of struggling with traditional methods.
• Ketamine vs. Spravato (Esketamine): The video contrasts the generic, lower-cost ketamine with the branded, significantly more expensive Spravato nasal spray, which is FDA-approved for treatment-resistant depression but often gate-kept by PBMs due to cost.
• Fertility Benefits as an Analog: The evolution of fertility benefits, where access expanded beyond strict clinical diagnoses to include future planning (e.g., egg freezing, surrogacy), is used to illustrate how psychedelic therapies could similarly gain broader acceptance and employer sponsorship.