United States Minor Outlying Islands

Reimbursed Care Access

United States Minor Outlying Islands are subject to federal U.S. law and federal drug scheduling; they lack their own healthcare system or separate drug-regulatory regime. FDA-approved psychedelic-related medicines (currently only esketamine/SPRAVATO) may be accessed under the same federal rules that apply in the 50 states (administration in certified healthcare settings, REMS requirements, possible private-insurer or Medicare/Medicaid coverage subject to payer rules). All classic psychedelics (psilocybin, MDMA, DMT, 5‑MeO‑DMT, mescaline, many 2C series compounds, ibogaine) remain controlled under federal law and are only available legally through DEA-authorized research, or in narrow religious exemptions in specific court-approved cases (e.g., ayahuasca/UDV).