Psychedelic-Assisted Therapy and Health Insurance in Australia

Earlier this year, Medibank, Australia’s largest private health insurer, announced a scheme where they dedicated $10 million to providing coverage for MDMA assisted therapy (MDMA-AT) for PTSD, in partnership with Emyria, to be provided via their Empax Centre.

This came to my attention again more recently when Optimi Health got a little over-excited with their public communications regarding a purchase of their product, in conjunction with the expansion of this scheme to include psilocybin assisted therapy (PAT) for treatment resistant depression.

Given that insurance coverage for mental health in Australia is often notoriously mean, I was curious about how this would work and what the out-of-pocket costs to people seeking this treatment under this pilot program would be? No one seemed to be talking specifics, if the scheme was mentioned at all.

I reached out to both Medibank and Emyria, with a view to getting a clearer idea on what the costs for people getting this treatment would be. While Medibank never got back to me, I did get a reply from Emyria CEO, Michael Winlo.

One sentence in his email to me stood out, for obvious reasons:

‘Once a MBP customer has successfully passed our clinical screening and had their policy eligibility confirmed, a full, 3 treatment cycle could be as low as $0 for some customers but there is a wide range of policy options as I’m sure you can appreciate.’

 I’m going to be honest, due to my cynicism and lack of experience working with health insurers, this is not the answer I expected. So, when he offered to have an additional chat to clarify how this worked, I was secretly relieved.

Photo by Marek Studzinski on Unsplash‍ ‍

How is there no out-of-pocket?

A big part of how this cost is so low is that while extras cover for mental health might be lacklustre, even with good coverage, for hospital costs, gold-level hospital policies generally cover inpatient psychiatric costs with little or no out of pocket cost. (Hat tip to Steve Bright of PRISM & Edith Cowan University for making me aware of this aspect.) In this case, Medibank has committed that, in partnership with Emyria, eligible Medibank customers will be able to access these treatments at Empax Centre in Perth and, more recently, the Avive Clinic in Brisbane.

By all accounts this deal was a long time coming, with Winlo stating that it had taken years of discussions with the insurer to get to this point.

This should all be big news, right? Any mental health treatment having near $0 out of pocket costs in Australia is a big deal. For PAT or MDMA-AT, with costs running anywhere from $15,000-$30,000 AUD for a full course of treatment, that clients might only paying fraction of this (or nothing at all) is, frankly, amazing.  So why is this so low profile?

Apart from the considerable TGA restrictions on advertising psychedelic therapy, Winlo cited the complexity of individual treatment costs as the other reason to not publicly make a big deal out of this. Variations in screening and assessment, factors impacting treatment timing (e.g., the need to taper SSRI medication) and the client’s insurance coverage all alter the eventual out of pocket costs. So, while Emyria and Medibank can aim for as little cost to the client as possible, they’re not at a stage where they can give a blanket figure or guarantee due to the bespoke nature of each case.

This makes sense, from a commercial viewpoint, but also because over-promising in this area, when potential clients are so vulnerable, would be deeply unethical.

In our conversation, Winlo agreed that the other reason why an approach of just quietly getting things done makes sense is that the field does not need any more hype. The level of interest in these potential therapies isn’t lacking – but real-world data on efficacy, safety and cost-effectiveness is. That, and there are not many approved prescribers. The work of preparation, dosing, and integration is itself emotionally gruelling for the professionals undertaking it. So, making a huge fuss over what is still essentially an experimental treatment, that very few psychiatrists can provide, would be counterproductive at best. 

Nonetheless, this is a big deal. But it’s still important to put it in perspective.

What about the rest of us?

Clearly, in Australia with our hybrid sort-of-but-not-really universal healthcare system, private health coverage doesn’t completely solve the problem. As of June 2025, only 45.4% of people here have private hospital coverage. And the number of people purchasing top-level ‘gold’ cover that would allow them to access this with minimal out-of-pocket cost has reportedly plummeted to just 11% (who, in many cases will already be more likely to have the savings to pay for these treatments outright anyway.)

While it is true that the number of Australians purchasing this level of insurance has dropped rapidly, legislation gives consumers a one-off opportunity to upgrade their hospital cover for mental health without the normal two-month waiting period. In this instance, Medibank customers with more modest policies could if they could afford it) get the higher-level policy at short notice if they weren’t otherwise eligible. If other insurers entered similar arrangements, this option would be open to pretty much anyone with any level of private hospital coverage. 

What about the other 54.6% of people, who have no private hospital cover? For them to benefit from something like what Emyria is doing, they’d almost certainly have to purchase some level of hospital cover and go through the two-month waiting period, before using the waiver to upgrade to gold-level without additional waiting times, and then retain that higher level of cover for at least the duration of the treatment – possibly longer.

Even under the most ideal conditions, this is likely to cost someone in the ballpark of $1000, or quite a bit more, depending on their age and how long they need the higher level of cover post-treatment. But even if someone ended up paying for a year of gold cover, that’s going to be much cheaper than paying the full cost of an entire course of PAT or MDMA-AT treatment.

The truth is, though, this is still beyond the reach of many people, especially those for whom depression or PTSD have impacted their ability to work. Even a duel-income household is going to struggle to find an extra $60 a week (the approximate cost of top hospital cover with Medibank) if they’re putting most of their take-home pay into housing, energy bills & other living expenses. And, given the level of abject under-funding that most state mental health systems are dealing with, it will be an exceptionally long road to publicly-provided services of this nature. Perhaps, if the private insurers can show real-world efficacy and cost-effectiveness, there might be some movement by the states, eventually. Don’t hold your breath, though.

In the meantime, the behind the scenes work quietly continues. Winlo predicts that once the results of the Medibank trial and associated ANU cost-effectiveness study are available, other insurers will come to similar arrangements, and eventually (hopefully) accessibility will grow without a great deal of fanfare.

None of this is to say that the lack of popular attention on this process should mean avoiding scrutiny on these therapies. Their scientific and philosophical underpinnings, clinical efficacy, who is providing these therapies and how they are doing so, are all legitimate and important subjects for rigorous and unflinching enquiry. As PAT and MDMA-AT are used in more real-world contexts, their application inevitably becomes more complex. Increased numbers of providers and clients mean more potential for people’s lives to be improved, but also more opportunities for ethical failure and harm.

In Australia, even if this quiet change comes to pass, critical voices will still be essential. But it might be a refreshing situation if we’re needed to mostly do substantive ethical, conceptual, and clinical work, rather than spending quite so much energy on countering hype that is more concerned with share prices than whether or not psychedelic therapies actually work.