Flow starts US sales of its depression headset at $2,200 out of pocket for 10 weeks

The prescription can come over telehealth, so a patient can start from home ^[17]. Twelve months of Flow's monthly fee is $3,900 ^[1]. A patient who starts the course in January and is still wearing the headset in December has paid about $5,350 ^[2].

Flow stimulates the same part of the brain as transcranial magnetic stimulation, which requires clinic sessions five days a week over several weeks and can cost up to $15,000 without insurance ^[12]. Measured against that, the subscription costs less for roughly three and a half years, at which point cumulative payments reach the same $15,000 ^[3]. Most patients will not be comparing it with TMS. With about one in six American adults taking an antidepressant ^[3], the comparison is with the pill bottle, and Wired reports those drugs are usually covered by insurance and cost far less than the device, though it gives no dollar figure for them ^[8].

The clinical evidence holds up. In a trial of 174 people with major depressive disorder, 45 percent using Flow's device were in remission at 10 weeks, against 22 percent on a sham version ^[9]. The gap of 23 points works out to roughly four patients treated for each additional remission ^[4]. Reported side effects were mild, including skin irritation and headaches ^[10]. Daniel Mansson, a clinical psychologist before he cofounded Flow ^[19], said: "In order to have a real impact on the problem, you need to create something that has the effect on the brain needed, but that can be used in a home environment in a safe and effective way." ^[13]

Vinod Khosla, an early investor, said: "My bet is, if you ask any person who's on depression drugs, they'd prefer not to be on them." ^[14] He added: "They'd like a nondrug, nonchemical treatment for it." ^[15] That preference is believable, and it now has to hold up against a $2,200 charge when the alternative is a copay ^[6][8].

Europe is where the usage record sits. The device has been approved there since 2019, more than 65,000 people have used it, according to Mansson, and the UK's National Health Service is piloting it ^[16]. In those systems one payer can decide for a whole population. In the US, Mansson said the company is working to get reimbursement from insurers ^[7].

Anyone pricing a cash-pay device against a reimbursed default has two questions to answer: who pays for the first course, and who pays for the maintenance months after it. With Flow, the patient pays for both ^[6]. The trial measured remission at 10 weeks, and the monthly charges begin after that ^[9][6].