Our clinic does not bill any insurance directly for consultations, infusions, or for medical services of any kind relating to ketamine infusion.

Dr. Lawinski is considered an out of network provider for some insurance plans, typically for insurance plans designated as PPO.   In these cases, these insurances may offer reimbursement  to the patient for fees paid to the doctor. These reimbursements are typically around 50% of fees paid to the doctor for evaluation and management of medical conditions and the IV infusion itself.

No insurance reimbursement is possible for the cost of the compounded ketamine prescriptions at the pharmacy  in any circumstance.

Dr. Lawinski is opt out of medicare and so no reimbursement is possible for services rendered to medicare patients.  However, since Dr. Lawinski is registered with PECOS, lab testing and imaging studies performed as a part of medical care will typically be covered through medicare payments directly to the lab or imaging facility.

Esketamine is a new medication related to generic ketamine that is covered by insurance and that is available through a board certified psychiatrist.  Dr. Lawinski does not use or prescribe esketamine in his practice.

Generic ketamine is considered off label and therefore is not covered by insurance for the treatment of depression mood disorders or chronic pain. A related medication, with a similar mechanism of action, called esketamine, was approved by the FDA in March 2019 for treatment resistant major depressive disorder, and is typically covered by insurance. For a detailed discussion of the differences between ketamine and esketamine, please see FAQ #3 below.

DesIn March of 2019, the FDA approved a new patented pharmaceutical medicine for the treatment of major depressive disorder, called esketamine (brand name Spravato). Esketamine and ketamine are very closely related, in fact, they differ only in their mirror image orientation. Therefore, both share a similar pharmacologic mechanism, which is NDMA receptor antagonism.

While esketamine and ketamine work by similar molecular mechanisms, and may be similar in their effectiveness, the differences in the use of these medicines are striking and are created from our current legal, and economic framework.

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Firstly, as a generic medication, which can be created by a wide variety of manufacturers, ketamine doesn’t make the drug companies a lot of money, due to the principals of economic competition. In contrast however, since esketamine is patented, the drug companies, under our current drug pricing laws, profit immensely from its sale. Off the record, one estimate I have from a pharmacist is that one year of esketamine treatment for one patient results in gross revenue of $70,000 for Janssen Pharmaceutical Companies of Johnson & Johnson, the current sole manufacturer of esketamine, a cost that is born by the health insurance companies. Astronomical profits of this kind for patent drugs are often to blame for America’s skyrocketing insurance costs and for the unsustainable cost of delivering health care for all citizens of this country. Generic ketamine, as administered in our clinic, entirely bypasses the market of insurance based patent pharmaceuticals sales.

Secondly, while insurance covered esketamine has an FDA approval for treatment resistant major depressive disorder, generic ketamine is used “off label” for this purpose. Off label in general means that a medical doctor can use any FDA approved medication for any purpose and in any manner they deem appropriate, based on their professional judgment and current standards of medical practice. In contrast, FDA approval means the government has decided what a medication can be used for and the exact way in which doctors must use it. FDA approval of esketamine means that insurances will cover esketamine for treatment of resistant major depressive disorder in most cases. FDA approval for esketamine also means that doctors who prescribe it are bound to government and pharmaceutical industry created rules regarding its use, according to what the FDA approves. In contrast, generic ketamine, since used off label, has more flexibility. For instance, doctors can choose the route of administration of ketamine to use it as an infusion, or a sublingual lozenge, while esketamine is available as a nasal spray only. Furthermore, with generic ketamine, doctors have the flexibility to treat other disorders besides just resistant major depression such as depression associated anxiety, PTSD, and chronic pain, while esketamine is FDA approved for resistant depression only. As another example, in some cases, nasal spray ketamine can be approved for home use, while FDA approved and patented esketamine is approved for use in the physician’s office only.
Perhaps the most significant consequence of esketamine being FDA approved and insurance covered is that its use is limited to the nasal spray application according to strict schedules and procedures. Not only is intravenous infusion not an option with esketamine, but patients using esketamine can only use the medication in the doctor’s office twice a week and need to be monitored in the office for 2 hours post every administration. Generic ketamine in contrast has the flexibility that it can be used as an intravenous infusion in the office and that sublingual forms can be used at home. This flexibility could theoretically be of medical benefit. For instance, the effectiveness of intravenous ketamine versus sublingual esketamine has not been compared head to head. Therefore, we don’t scientifically know which one works better. However, many patients tell us that the intravenous infusion of ketamine is more powerful and more effective for the treatment of severe, resistant major depression.

At Kilauea ketamine clinic, we give patients the option of intravenous ketamine administration, in case the intravenous option is more effective for them than the insurance covered intranasal option. We also offer the choice to use intranasal ketamine at home as opposed to having to use intranasal esketamine only in a supervised setting. Finally, generic ketamine can be used off label in our clinic for a wider variety of conditions than just resistant depression, including anxiety, PTSD and chronic pain disorders in which depression is a prominent feature.
In summary, the legal classification of generic ketamine, versus patented esketamine, results in increased flexibility and freedom for the doctor to determine the most appropriate use of ketamine for each particular patient, bypassing the system of insurance based regulation. All patients are free to consult esketamine prescribers to see if that medication is right for them, or alternatively schedule an initial consultation with Dr. Lawinski to see if generic ketamine is a better choice.

We believe that clinical setting is a crucial component of the ketamine experience.

As described above, other clinics may be using esketamine which is a patented FDA approved medication with a similar mechanism of action to ketamine. This medication is used differently than ketamine with the major differences summarized below:

Generic ketamine can be used as an intravenous medication, while insurance covered esketamine cannot

Generic ketamine can be used at home as a prescription while insurance covered esketamine cannot.

Esketamine is only available through a board certified psychiatrist, and so therefore has extremely limited availability.
For more details please read FAQ #3, above

Ketamine does have a history of being used as a street drug or party drug and its improper use can result in intoxication. However, when ketamine is used in a medical setting the dosages and route of administration are much different than recreational street use. Also when used in a medical setting, the intention of using ketamine is not to get high, but to achieve long term improvement in depression symptoms, or other mood symptoms, and chronic pain. Use of ketamine other than that authorized by the doctor as a part of your medical treatment plan is strictly forbidden. In addition, the doctor will screen for inappropriate use of ketamine and other street drugs as part of your ongoing treatment. Ketamine can only be used as prescribed by your doctor and in many cases, especially during the initial stages of treatment, its use must be done while under direct medical supervision at our medical clinic.

Ketamine was FDA approved as an adjunct to surgical anesthesia in 1970. The doses we use for intravenous ketamine to treat major depression, mood disorders and pain are only a fraction of the dose used for anesthesia during surgery. At these much smaller doses, ketamine does not induce anesthesia, however, it can produce changes in perception and cognition, in addition to producing long term changes in mood symptoms and chronic pain symptoms. For this reason ketamine can only be used as prescribed by your doctor and in many cases, especially during the initial stages of treatment, its use must be done while under direct medical supervision at our medical clinic.

Ketamine is a Schedule III Controlled Substance under State and Federal law, FDA approved as an adjunct for general anesthesia, and prescribed for the off label indications of severe treatment resistant depression, mood disorders, and chronic pain.

Scientists are looking at ketamine as a way to control nerve damage caused by glutamate excitotoxicity. Glutamate excitotoxicity, mediated by the NMDA receptors, may be a way that long term inflammation and/or acute injury result in long term brain damage. By blocking the NMDA receptors, ketamine may have a use for mitigating this type of brain damage.