Considerations for Scaling Psychedelics: Context, Reimbursement, and the Role of the Pharmacy Benefit Manager
Derek Lukacsko
Zenodo (CERN European Organization for Nuclear Research) September 1, 2026 preprint DOI: 10.5281/zenodo.23025978 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper |
|---|---|
| Key points | Argues that psychedelic therapies face a Context–Reimbursement Paradox: because therapeutic effect depends heavily on set, setting, therapeutic relationship, and integration, these interventions are difficult to translate into the discrete, billable units that existing health care payment systems recognize. Identifies valuation, duration (the Durability–Churn and Durability–Revenue dilemmas), and delivery as three coverage challenges, and contends that drug pricing decisions will shape the role of pharmacy benefit managers along a compatibility gradient from SSRIs to psilocybin therapy. |
Abstract
Psychedelic therapies have shown considerable promise in clinical trials, but their effects depend heavily on context—set, setting, therapeutic relationship, and integration—in ways that sit uneasily with health care systems built to finance discrete drugs and billable services. This white paper examines the institutional pathway through which psychedelic therapies may reach patients, from regulatory approval to clinical delivery, payment, and practical access. It reviews the emerging cost-effectiveness literature and identifies three challenges for coverage: valuation (what counts as benefit), duration (the Durability–Churn and Durability–Revenue dilemmas), and delivery (labor intensity and delivery design). It describes a Context–Reimbursement Paradox: the more central context is to therapeutic effect, the harder the intervention is to translate into units that existing payment systems recognize. It then analyzes where pharmacy benefit managers (PBMs) fit along a gradient of compatibility, from SSRIs to psilocybin therapy, and argues that drug pricing decisions will shape their role. It closes by considering Indigenous knowledge systems and non-medical pathways to access.