Psychedelic therapy is expensive. Could group settings make it more affordable?

Psychedelic therapy for people living with HIV could be a public health boon. But first, it has to be accessible.

The FDA has yet to approve a psychedelic therapy protocol, but therapeutic psychedelic experiences have nonetheless become a commodity in the US and beyond—a very expensive one. Because psychedelic clinics operate in medical and legal gray areas, treatments are rarely covered by insurance, and sometimes require patients to travel abroad. These therapeutic retreats can cost over $10,000, even before plane tickets. This means that vulnerable populations who could most benefit from psychedelic interventions, like youth living with HIV, are often unable to access them, said Parya Saberi, a prevention science professor at the University of California, San Francisco.

At AIDS 2026 in Rio de Janeiro, Saberi presented a poster on her research about youth living with HIV and their experiences with psychedelics. Participants who had tried psychedelics reported a variety of mental health benefits, including relief from depression and anxiety, greater peace and spiritual growth. But as Saberi pointed out in a recent comment for The Lancet HIV, the psychedelic research community has paid little attention to the population of people living with HIV.  

This is especially concerning because people living with HIV often struggle with the very mental health challenges where psychedelic therapy shows promise, and the public health implications are huge.  As Saberi and coauthor Nelson Vergel wrote in The Lancet HIV, “A global systematic review estimated that PTSD affects approximately 28% of people with HIV, several-fold higher than estimates in the general population." Depression rates are also unusually high in this population. Untreated, these conditions can worsen health and mortality outcomes, and are associated with patients missing appointments or struggling to adhere to antiretroviral medications, according to Saberi’s comment. Antiretroviral medications stop HIV from multiplying, so the immune system stays healthy and patients are able to feel better and protect their partners from transmission.

If and when the FDA approves future psychedelic therapies, cost could continue to be an issue for people living with HIV, who are also more likely than the general population to be experiencing poverty. One of the reasons psychedelic therapy tends to be expensive is because it requires a lot of one-on-one time between a patient and a provider. Group therapy settings could be a way to improve accessibility “for folks with wide ranges of income and circumstances,” Saberi said.

Why is psychedelic therapy so expensive? 

Much of the psychedelic therapy on offer in the United States is focused on helping patients turn inward. They’ll be offered eye shades, noise cancelling headphones with soothing music, under the observation of a therapist who is available to help process the experience during and afterward.  The long dosing sessions coupled with multiple individual therapy sessions means packages are often thousands of dollars.  While the psychedelic component of these clinics may seem radical, the way patients are encouraged to look within for answers is in line with traditional psychotherapy. Protocols that invite patients to lie down, cover their eyes and listen to music are reminiscent of what the Multidisciplinary Association for Psychedelic Studies (MAPS) submitted for FDA approval. The FDA rejected MAPS' application in 2024 due to concerns about clinical trial data and safety. A key difference between the MAPS trial and the treatments on offer at US clinics is the drug that is provided. Clinics can legally administer ketamine to patients, while MDMA remains a schedule I controlled substance.

Spravato, a nasal spray formulation of ketamine, has been FDA approved for treatment-resistant depression since 2019. However, that approval came with rigid safety requirements, including that patients must be monitored for at least two hours. So many ketamine therapy clinics opted to instead prescribe compounded ketamine formulations, or formulations that were FDA-approved as anesthetics, both which can legally be used for off-label purposes—and with a lot less red tape. The problem is that insurance companies still consider these off-label treatments “experimental” and can refuse to cover them.