Pending · due 3 Sep 2028

A US health insurer, health plan or public program publishes a coverage policy that covers intravenous ketamine for bipolar depression.

TRUE on the effective date of a published medical or coverage policy, fee schedule entry, national coverage determination, local coverage determination or public policy bulletin from a US health insurer, health plan or public program (a commercial plan, Medicare, Medicaid or the VA) that lists intravenous ketamine as covered or medically necessary for bipolar depression. A policy that covers esketamine (Spravato), a policy limited to major depressive disorder, an individual case exception, coverage limited to a clinical trial, and a payment for the infusion visit without the drug do not count. FALSE at the deadline when no such policy is in force. Resolved on the payer's published policy bulletin and the CMS Medicare Coverage Database.

Resolution source: Payer medical policy bulletins; CMS Medicare Coverage Database

Readings: 'Meaningful coverage' is read as at least one published US health plan coverage policy for the indication; the forecaster names no payer, so any US health plan or public program counts, as in E-0116.; 'IV ketamine. For bipolar depression.' fixes the asset and the indication; esketamine is a different product and does not count.; The KET-BD trial result is the reason the forecaster gives, not part of the criterion.