The Bottom Line
At-home ketamine troches cost approximately $100-400 per month for ongoing therapy. Clinic-based IV infusions cost approximately $400-800 per session, with monthly maintenance running $800-3,200 depending on frequency. Over a year, the difference can exceed $10,000. For a broader price comparison that includes Spravato and IM injections, see our full cost comparison.
Per-Session Cost Breakdown
Troche Session
| Cost Component | Amount |
|---|---|
| Medication (per troche) | $1-15 |
| Provider fee (prorated monthly) | $10-30 per session |
| Total per session | $11-45 |
IV Infusion Session
| Cost Component | Amount |
|---|---|
| Ketamine medication | $5-20 |
| Clinic facility fee | $200-500 |
| Medical supervision | $100-200 |
| Monitoring equipment | Included in facility fee |
| Total per session | $400-800 |
The Initial Treatment Phase
Troches (First 6 Weeks)
- 2-3 sessions per week for 4-6 weeks = 8-18 sessions
- Total cost: $88-810
- Average: approximately $300-500
IV Infusions (First 3 Weeks)
- Standard protocol: 6 infusions over 2-3 weeks
- Total cost: $2,400-4,800
- Average: approximately $3,000-3,600
Monthly Maintenance Costs
Troches
- 4-8 sessions per month (weekly to twice weekly)
- Medication: $4-120
- Monthly provider consultation: $50-150
- Monthly total: $100-400
IV Infusions
- 1-2 sessions per month (typical maintenance)
- Monthly total: $400-1,600
Annual Cost Comparison
| Troches | IV Infusions | |
|---|---|---|
| Initial phase | $300-800 | $2,400-4,800 |
| 12 months maintenance | $1,200-4,800 | $4,800-19,200 |
| Year 1 total | $1,500-5,600 | $7,200-24,000 |
Hidden Costs Most Patients Overlook
IV Infusion Hidden Costs
- Transportation: Gas, parking, or rideshare fees for each clinic visit (you cannot drive after treatment). At $20-50 per round trip, this adds $240-600 annually for monthly maintenance.
- Lost wages: Each clinic visit requires 3-4 hours including travel and recovery time. For hourly workers, this is direct income loss.
- Childcare: Parents may need childcare during clinic sessions.
Troche Hidden Costs
- Shipping: Some pharmacies charge $10-25 for overnight shipping of controlled substances.
- Supplies: Eye mask, blood pressure cuff (if provider requires home monitoring), anti-nausea medication.
- These are minor compared to IV hidden costs and are typically one-time or infrequent expenses.
Insurance Coverage
Neither at-home troches nor off-label IV ketamine infusions are typically covered by insurance. Patients pay out of pocket for both. Some exceptions:
- A small number of providers can code IV infusions under pain management or psychiatric billing codes that may receive partial reimbursement
- FDA-approved Spravato (esketamine nasal spray) has broader insurance coverage but requires in-clinic administration and carries its own high costs
For most patients, the cost comparison is a direct, out-of-pocket comparison — and troches win decisively on affordability.
What the Cost Difference Means for Treatment
The cost gap has real therapeutic consequences. Many patients who respond well to an initial IV infusion series cannot afford ongoing maintenance infusions. Their symptoms return, and the investment in the initial series is partially lost.
Troches, by contrast, are affordable enough for indefinite maintenance — allowing patients to sustain the therapeutic gains achieved during acute treatment over months and years.
References
- At-Home Oral Ketamine for Depression — Real-world cost and outcome data from at-home ketamine therapy programs
- Comparison of Ketamine Administration Routes — Systematic review including cost-effectiveness data across delivery methods
- NIMH: Ketamine Research — National Institute of Mental Health overview of ketamine treatment accessibility
- Mayo Clinic: Treatment-Resistant Depression — Overview of treatment costs and access barriers for refractory depression
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