Crunching the Numbers on Psychedelic Therapies:

Cost, Coverage, and Access

By: Elliot Marseille, DrPH, MPP; Director, Collaborative for the Economics of Psychedelics, UC Berkeley

The psychedelic resurgence has reached a critical juncture. While clinical trials demonstrate remarkable efficacy for MDMA and psilocybin-assisted therapies, among others, in treating conditions like PTSD and major depression, a fundamental question remains: Can these treatments become accessible to the millions who need them? The answer lies not just in regulatory approval, but in the economics that will determine whether insurers cover these therapies and healthcare systems adopt them at scale.

Perhaps the most important economic question is not whether psychedelic therapies are cost-effective, but how to ensure equitable access. Without deliberate planning, these treatments risk becoming boutique therapies for the affluent rather than transformative public health interventions.

Group therapy models, being explored both in the United States and abroad, offer one pathway to democratizing access⁷. Training programs that credential a diverse workforce of therapists—not just psychiatrists and psychologists but social workers, counselors, and peer support specialists—could help meet demand while controlling costs. Innovative payment models, such as outcomes-based contracts where manufacturers share risk with payers, might accelerate adoption.

The economics of psychedelics ultimately serve a larger purpose: turning scientific breakthroughs into accessible treatments for those who need them most. Whether it’s a veteran in rural America, a conflict survivor in Ukraine, or anyone struggling with treatment-resistant mental illness, the goal remains the same—ensuring that ability to pay doesn’t determine access to healing.

While MDMA for PTSD has captured headlines, it represents just the beginning of psychedelic medicine’s economic potential. Across the spectrum of mental health and behavioral disorders, emerging therapies show promise that could fundamentally reshape healthcare economics.

Consider ibogaine for opioid use disorder. Early studies suggest that a single ibogaine treatment could interrupt addiction patterns that typically require months of conventional medication-assisted treatment⁸. For traumatic brain injury, affecting millions of veterans and civilians, preliminary research indicates ibogaine might offer neuroprotective benefits where conventional treatments have failed⁹. The economic implications are staggering: if even partially effective, these interventions could save thousands of lives while reducing the enormous burden on emergency departments, criminal justice systems, and families.

Psilocybin-assisted therapy presents similarly compelling economics across multiple indications. For tobacco cessation, where traditional quit rates hover around 15-30%, early trials show success rates exceeding 80% at six months^10,11. Given that smoking still kills more than 480,000 Americans annually and smoking costs the U.S. over $600 billion annually, even modest improvements in cessation rates could generate billions in savings12.  Alcohol use disorder affects over 29.5 million Americans and costs society about $249 billion yearly13. Thus, psilocybin’s ability to reduce heavy drinking days and promote abstinence could transform both individual lives and public health budgets14. Our team at CEP is modeling these scenarios, and preliminary analyses suggest cost-effectiveness ratios that would make these treatments attractive to even the most conservative payers.

The therapeutic landscape extends further still. LSD for generalized anxiety disorder, affecting 6.8 million American adults, could offer relief where SSRIs and benzodiazepines often fall short. DMT for treatment-resistant depression—a condition affecting millions who have exhausted conventional options—might provide rapid relief similar to ketamine but with potentially longer-lasting effects. Each of these indications represents not just clinical opportunity but economic necessity. The cumulative burden of mental health and substance use disorders exceeds $1 trillion annually in the United States alone when accounting for healthcare costs, lost productivity, and premature mortality.

What makes these therapies particularly compelling from an economic standpoint is their potential for durable responses after limited treatment courses. Unlike traditional psychiatric medications requiring daily dosing for years or decades, psychedelic-assisted therapies typically involve just a few sessions. This fundamental difference in treatment architecture could revolutionize mental healthcare economics—shifting from chronic disease management to potential long-term remission or (dare we say it?), cure.

Of course, the evidence base varies considerably across these applications. While MDMA for PTSD and psilocybin for depression have advanced to Phase 3 trials, other indications remain in earlier stages of investigation. Yet the consistency of positive signals across diverse conditions and compounds suggests we’re observing a genuine therapeutic class effect rather than isolated successes. For health economists, this presents both opportunity and challenge: how to model the potential impact of therapies that might fundamentally alter disease trajectories in ways our current frameworks struggle to capture.

As the field advances, economic analysis will play an increasingly central role in shaping the psychedelic therapy landscape. The expanding pipeline of psychedelic therapies—from established compounds like MDMA and psilocybin to emerging treatments with ibogaine, LSD, and DMT—demands sophisticated economic modeling that can capture both immediate costs and long-term societal benefits. The work being done now—developing cost-effectiveness models, analyzing payer perspectives, designing equitable access frameworks—lays the foundation for a future where these treatments are not exotic experiments but standard care options.

The recent FDA setback for MDMA-assisted therapy, while disappointing, provides an opportunity to strengthen the economic evidence base. Additional trials, if designed with economic endpoints in mind, could address payer concerns while generating the real-world evidence needed for broad implementation.

The promise of psychedelic therapies extends beyond individual healing to societal transformation. By demonstrating their economic value—not just their clinical efficacy—we can build the case for the infrastructure, training, and coverage policies needed to realize this potential. The numbers tell a compelling story: these therapies can save lives, reduce suffering, and generate economic value. Our task now is to ensure that story reaches the decision-makers who hold the keys to access.

The emergence of psychedelic-assisted therapies represents a rare opportunity to fundamentally improve mental healthcare while potentially reducing its economic burden. Through rigorous economic analysis, thoughtful implementation strategies, and commitment to equity, we can help ensure these treatments fulfill their transformative promise—not just for some, but for all who need them.