Compass Says Spravato Clinics Are the Blueprint for Its Upcoming Psilocybin Drug. 70% of Ketamine Clinics Aren’t Certified
Compass Pathways says the clinics that will deliver its psilocybin drug already exist. Its executives told BioPharma Dive there are about 8,500 interventional psychiatry sites, and called the infrastructure ready and waiting. We counted our own directory to see how many ketamine clinics are actually on that rail. Most are not.
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| Key Takeaway | Detail |
|---|---|
| Our count | 1,648 published ketamine clinic listings in the HealingMaps directory |
| On the Spravato rail | 492 listings carry Spravato, and 469 of those also offer ketamine |
| Not on it | 1,179 ketamine clinics, 72 percent, have no Spravato line at all |
| The visit math | Spravato runs 25 to 50 visits a year; Compass expects COMP360 one to four times |
| The offset | Compass says sites bill per hour in the chair, above Spravato rates |
| The unknown | About 40 percent respond to a second dose, and nobody can predict who |
What Compass Told BioPharma Dive
Chief Patient Officer Steve Levine said there were a handful of clinics able to run multi-hour monitoring when Spravato launched in 2019. Today he puts it at about 8,500, with spare capacity.
Spravato brought in more than $1 billion in the first half of 2026. We covered its climb toward blockbuster status as the rails were being laid.
Compass expects to finish its FDA submission in the fourth quarter. CEO Kabir Nath described the plan as going slow to go fast, with a contained launch before scaling.
The Visit Math Is the Part Operators Should Read Twice
Levine described Spravato as 25 to 50 day-long treatments per year, each about a three-hour visit. He expects COMP360 to be a one to four times per year treatment.
That is a different revenue shape. A Spravato patient returns dozens of times. A COMP360 patient may come once or twice, then not again for months.
These are per patient numbers, and the arithmetic adds up fast. Twenty Spravato patients at 40 visits each produce 800 appointments in a year. Twenty COMP360 patients at two sessions each produce 40.
Longer sessions close part of that gap, because each COMP360 appointment occupies a room for six to eight hours rather than three. The rest has to come from volume. A practice building a psilocybin service line needs a much larger pool of patients to keep the same rooms working.
Compass says it built the reimbursement framework so sites are paid for every hour in the chair. It expects that rate to exceed Spravato. A six to eight hour session billed hourly is the offset to a patient who visits far less often.
Whether that math works depends on throughput per room. We examined the same question in our piece on session length and chair economics.
What Our Directory Actually Shows
We counted published listings in the HealingMaps directory on October 5. There are 1,648 ketamine clinic listings and 492 Spravato listings.
The overlap runs almost entirely one way. Of the 492 Spravato listings, 469 also offer ketamine, which is 95 percent. Only 23 Spravato listings have no ketamine line.
Read from the other direction, the picture changes. 1,179 ketamine clinics, 72 percent of the field we track, carry no Spravato at all.
So the infrastructure Compass describes is real, and it is a minority of ketamine clinics. The rail exists. Most operators are not standing on it.
The Interventional Stack Is Narrower Still
We also track 297 clinics offering TMS. Of those, 196 also offer Spravato and 265 also offer ketamine.
That cluster runs ketamine, Spravato and TMS in the same building. It is the profile Levine described: multiple rooms, multidisciplinary staff, one prescriber on site.
It is a couple hundred practices in our data, not thousands. Compass counts a larger universe than a ketamine directory sees, because interventional psychiatry includes sites that never offered ketamine.
What Getting On the Rail Requires
Spravato is dispensed under a REMS program, so a site has to be certified. That means monitoring space and staff for the observation window.
It also needs payer contracts, because Spravato revenue is insurance revenue. That is the part a cash pay ketamine practice has usually never built.
Clinics weighing this should treat it as a two year decision rather than a launch week decision. Certification, credentialing and billing infrastructure do not arrive quickly.
The Staffing Question Has Two Competing Answers
Levine described COMP360 as drag and drop, slotting into how these centers already run, with the same staff monitoring patients.
That is a very different model from the one in the Israeli MDMA trials, where two therapists sit with one patient for every session.
If psilocybin delivery really needs only a team-based monitoring model, the cost per patient stays close to today’s Spravato economics. If regulators require more, it does not.
The 40 Percent Nobody Can Predict
Nath was direct about the limit. About 40 percent of patients have a clinically meaningful response to a second dose, and the field cannot yet say who they will be.
For a clinic, that is a scheduling and expectations problem as much as a clinical one. A majority of patients may go through a long session without the result they came for.
It is also the argument for measuring. A practice that tracks its own response rates will know what it delivers, which is the case we made in our piece on outcomes as a moat.
The Bottom Line
Compass is right that it does not have to build clinics. It is also describing a launch that runs through a minority of the ketamine field.
For the 72 percent without a Spravato line, this approval would not be an opportunity waiting at the door. It would be a build, and the time to decide is before the drug arrives.
Directory figures are from a HealingMaps analysis of published listings on October 5, 2026. Compass figures are from the company’s BioPharma Dive interview, published September 21, 2026.
We covered the launch strategy itself when Virginia’s trigger law passed, in our piece on why the first psilocybin clinics will probably be Spravato clinics.
Patients looking for supervised care can start with our directory of verified ketamine clinics.
This article is for informational purposes and is not legal, financial or medical advice. COMP360 is not approved by the FDA.
