Psychedelic Assisted Psychotherapy (PAP) information for providers
An overview for providers on the funding criteria and process for submitting funding requests for PAP.
If you are a member of the veteran community go to Psychedelic Assisted Psychotherapy (PAP) for information.
The Department of Veterans’ Affairs (DVA) has been recently approved to fund MDMA for the treatment of post-traumatic stress disorder (PTSD) and psilocybin for treatment resistant depression (TRD), in combination with psychotherapy. This follows a Therapeutic Goods Administration (TGA) decision allowing Authorised Psychiatrists to prescribe medicines containing MDMA for the treatment of PTSD and psilocybin for TRD.
DVA is required to balance its legislative obligations to fund veteran healthcare against the risks associated with emerging treatments such as PAP. This means that strict clinical scrutiny will be applied to funding requests for PAP, and providers will be expected to provide additional information to confirm that this treatment is safe and necessary for the patient being treated.
Back to topEligible DVA clients
MDMA
The following DVA Veteran Card holders may be eligible for PAP using MDMA:
- Gold Card holders with a diagnosis of PTSD
- White Card holders with an accepted condition of PTSD
- White Card holders with Non-Liability Health Care (NLHC) for mental health conditions and a diagnosis of PTSD
Psilocybin
The following DVA Veteran Card holders may be eligible for PAP using psilocybin:
- Gold Card holders with a diagnosis of TRD
- White Card holders with an accepted condition of Major Depressive Disorder (or equivalent), and a diagnosis of TRD.
- White Card holders with Non-Liability Health Care (NLHC) for mental health conditions and a diagnosis of TRD.
Please note:
- A diagnosis of dysthymic disorder/Persistent Depressive Disorder (PDD) is not sufficient to justify psychedelic treatment funding.
Current Australian Defence Force (ADF) members
ADF members are not eligible for funding of PAP under DVA arrangements.
Veteran card holders residing or travelling overseas
PAP treatment will not be funded for treatment performed outside Australia.
Back to topPrior Treatment
PAP is considered a fourth-line treatment option. For a client to be eligible for PAP, there must be sufficient evidence that they have attempted multiple standard treatment options for PTSD or TRD, and that these attempts have been unsuccessful.
For requests for MDMA to treat PTSD the client must:
- have had an adequate trial of at least two (2) of the strongly recommended treatments for PTSD listed in Australian (International PTSD guidelines) guidelines for the prevention and treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD treatment, OR
- treatment combinations considered equivalent from the conditionally recommended list.
For requests for psilocybin to treat TRD the client must:
- meet the DVA definition for TRD – failure to achieve adequate response to two (2) or more courses of treatment of adequate duration (and dose for medications), AND
- have had an adequate trial of one or more established and DVA-funded treatments for TRD (e.g., adjunctive psychotherapy of adequate duration, medication augmentation strategies, repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), esketamine, ketamine).
Provider and provider team qualifications
PAP treatment is strictly controlled by the TGA. Under current regulations, only specialist psychiatrists who are registered with the Medical Board of Australia and who have TGA authority as an Authorised Prescriber can prescribe MDMA or psilocybin.
DVA requires that PAP treatment must be delivered or overseen by an Authorised Prescriber.
Other members of the immediate treating team – such as psychiatrists, clinical psychologists, and psychologists – must have completed an accredited PAP training course.
Back to topFunding of retrospective treatment
Due to the emerging nature of PAP treatment, retrospective funding is not available for treatment already provided or commenced.
Back to topRequests for retreatment
DVA will only fund a maximum of three dosing sessions with either MDMA or psilocybin.
We are only able to fund requests for retreatment where there are exceptional circumstances requiring this. Any request for retreatment will require extensive supporting evidence and will be considered directly by DVA’s Chief Psychiatrist.
Back to topTreatment delivery requirements
PAP treatment funded by DVA must comply with the following documents along with relevant Australian Government and State Government regulatory requirements.
Clinical Memorandum: Therapeutic use of psychedelic substances (RANZCP, June 2023)
Clinical Memorandum: Therapeutic use of MDMA for PTSD and psilocybin for treatment resistant depression (RANZCP, May 2023)
Treatment components
PAP treatment is expected to comprise the following components:
Initial assessment/screening sessions
- Must be delivered by the Authorised Prescriber.
- May be delivered either face-to-face or by telehealth.
Medication washout
The medication washout must be overseen by the Authorised Prescriber or treating psychiatrist.
Where requiring a hospital admission, the medication washout must be delivered in a DVA-contracted hospital.
Preparatory sessions
Must be delivered by the clinicians identified in section 17 of the D9538 form as delivering the dosing and associated psychotherapy sessions.
Dosing and associated psychotherapy sessions
- Two clinicians are required for dosing and associated psychotherapy sessions
- Dosing must occur in a clinically appropriate setting
Integrative psychotherapy sessions
Must be delivered by the clinicians identified as delivering the dosing and associated psychotherapy.
Handover of care to usual providers
Back to topHow to lodge an application
DVA will only accept funding requests from the Authorised Provider.
Treatment requests which are not submitted by the Authorised Provider will be returned.
All requests for PAP funding must be submitted on Form D9538 – Emerging Treatment Psychedelic Assisted Therapy Prior Financial Authorisation MDMA and Psilocybin.
This form has been specifically developed for PAP funding requests and requires a broader range of information to support each request, including evidence of the failure of multiple prior treatments.
All Prior Financial Authorisation requests for PAP must include:
- A completed Form D9538
- A fee breakdown covering number of sessions, frequency of sessions, medication cost (dose dependant), facility fee, dispensing fee, and other fees. Each fee component of treatment must be itemised rather than a single total figure.
- Confirmation of Authorised Prescriber status.
- Confirmation a second psychiatrist has been involved in assessing the need for PAP where the Authorised Prescriber is also the treating psychiatrist.
Fees
DVA is legally obligated to obtain ‘value for money’ in the expenditure of public monies.
As such, we require that PAP funding requests include an itemised list of fees for all MBS and non-MBS items. Individual fee items will be assessed on their merit.
MBS items must be costed at the rate specified in the relevant DVA fee Schedule:
MBS fees are not to be direct claimed.
The following items should form part of the PAP funding request:
- Initial assessment / screening sessions.
- Preparatory sessions.
- Dosing and associated psychotherapy sessions.
- Integrative psychotherapy sessions.
The following should be direct billed and should not form part of a PAP request:
- Medication washout involving a hospital inpatient admission.
- Hospital admission following an adverse event relating to therapy.
- Overnight hospital accommodation following a dosing session where an admission was necessary.
A daily facility fee of $600 may be charged to DVA. This covers administration, food and drink, facility use and includes consumables and nursing support.
Back to topRelated information
To find out about DVA’s program of mental health treatments available for eligible veterans and their families visit the Mental health programs overview page.
Back to top