Provider vs. provider
Sesame vs. Better U (2026): Standard Psychiatry or At-Home Ketamine?
Sesame vs. Better U compared — standard online psychiatry and therapy vs. at-home ketamine, costs without insurance, eligibility, safety and which is appropriate for you.
Our bottom line
Sesame is the more appropriate first step for most people who want affordable therapy or medication; Better U is only for adults whose symptoms haven’t responded to standard treatment.
Sesame vs. Better U: side by side
| Sesame | Better U | |
|---|---|---|
| Type of service | Online therapy, psychiatry and prescriptions | At-home ketamine therapy |
| Pricing | Each provider sets an upfront cash price you see before booking. Mental health visits from about $34; psychiatrist appointments average about $132 for 45 minutes. Mental Health Rx subscription $79/month. | Packages from $500 for 5 sessions ($100 each) to $2,076 for 27 sessions with 6 integration sessions ($76 each). Financing available. |
| Insurance | Does not bill insurance. HSA and FSA accepted. Your pharmacy may still run insurance for the medication itself. | Not covered by insurance. Payment plans offered through third-party financing. |
| Prescribes medication | Yes (non-controlled medications, where clinically appropriate) | Yes (non-controlled medications, where clinically appropriate) |
| Ages served | Adults for mental health care (Sesame also lists separate pediatric visits) | Adults who pass a medical and psychiatric screening |
| Services | Online therapy sessions with a licensed therapist; Online couples therapy sessions; Online psychiatry consults with psychiatrists and psychiatric nurse practitioners; Mental health consults and prescription refill visits with primary care providers; Mental Health Rx subscription for ongoing medication care; In-person mental health consults in some areas | Online eligibility assessment and free consultation; Psychiatric evaluation by a licensed clinician; Oral ketamine (lozenges) prescribed for at-home sessions, delivered by mail; Treatment preparation and integration coaching sessions; Companion app with guided programs and mood and symptom tracking; Holistic psychiatry, medication tapering support and talk therapy referrals |
| Availability | Online across the US, with providers listed by state. Sesame says psychiatrists are not available in every state. | About 30 US states (listed on Better U’s site); some in-office options, including Spravato, in select states. |
| Links | Visit Sesame (opens in a new tab)Read our Sesame review | Visit Better U (opens in a new tab)Read our Better U review |
- Type of service
- Online therapy, psychiatry and prescriptions
- Pricing
- Each provider sets an upfront cash price you see before booking. Mental health visits from about $34; psychiatrist appointments average about $132 for 45 minutes. Mental Health Rx subscription $79/month.
- Insurance
- Does not bill insurance. HSA and FSA accepted. Your pharmacy may still run insurance for the medication itself.
- Prescribes medication
- Yes (non-controlled medications, where clinically appropriate)
- Ages served
- Adults for mental health care (Sesame also lists separate pediatric visits)
- Services
- Online therapy sessions with a licensed therapist; Online couples therapy sessions; Online psychiatry consults with psychiatrists and psychiatric nurse practitioners; Mental health consults and prescription refill visits with primary care providers; Mental Health Rx subscription for ongoing medication care; In-person mental health consults in some areas
- Availability
- Online across the US, with providers listed by state. Sesame says psychiatrists are not available in every state.
- Type of service
- At-home ketamine therapy
- Pricing
- Packages from $500 for 5 sessions ($100 each) to $2,076 for 27 sessions with 6 integration sessions ($76 each). Financing available.
- Insurance
- Not covered by insurance. Payment plans offered through third-party financing.
- Prescribes medication
- Yes (non-controlled medications, where clinically appropriate)
- Ages served
- Adults who pass a medical and psychiatric screening
- Services
- Online eligibility assessment and free consultation; Psychiatric evaluation by a licensed clinician; Oral ketamine (lozenges) prescribed for at-home sessions, delivered by mail; Treatment preparation and integration coaching sessions; Companion app with guided programs and mood and symptom tracking; Holistic psychiatry, medication tapering support and talk therapy referrals
- Availability
- About 30 US states (listed on Better U’s site); some in-office options, including Spravato, in select states.
Details last verified September 26, 2026. Prices and coverage change often — confirm current details with each provider. Links marked as affiliate links may earn us a commission at no extra cost to you.Learn more
Sesame and Better U are both self-pay, but they offer very different treatment. Sesame is a marketplace for therapy and psychiatry, where clinicians prescribe standard, non-controlled medications. Better U is an at-home ketamine program for adults whose symptoms haven’t improved with standard treatment.
The short answer
- Start with Sesame if you haven’t yet tried standard treatment.
- Consider Better U only if you’re an adult whose symptoms haven’t improved after standard treatment, and after talking it through with a clinician.
How they compare
| Sesame | Better U | |
|---|---|---|
| Treatment | Therapy; psychiatry with non-controlled medication | Oral ketamine at home, with psychiatric evaluation and integration coaching |
| Where it fits | First-line care | After standard treatment hasn’t helped |
| Cost | Visits from about $34; Mental Health Rx $79/month | $500 (5 sessions) to $2,076 (27 sessions + 6 integration) |
| Insurance | Doesn’t bill insurance; HSA/FSA accepted | Not covered; financing available |
| Availability | Nationwide, by state | About 30 states |
A note on ketamine
Generic ketamine is FDA-approved as an anesthetic; prescribing it for depression or anxiety is off-label. The related drug esketamine (Spravato) is FDA-approved for treatment-resistant depression, but only under supervision in a certified clinic. At-home ketamine can raise blood pressure and cause dissociation, long-term evidence is still limited, and in 2023 the FDA warned about risks of compounded ketamine used at home for psychiatric conditions. Better U’s screening excludes many people for safety reasons — see our Better U review for the full list.
Using them together
If you do go on to ketamine treatment, keep a regular therapist and prescriber involved. Sesame can provide ongoing therapy or standard medication management alongside it.
Our verdict
For most people, Sesame is the more appropriate and affordable first step. Better U is a specialized option for treatment-resistant symptoms, to discuss carefully with a clinician.
If you have thoughts of suicide, call or text 988 in the US or call 911 — see Get Help Now.
Which should you choose?
Choose Sesame if…
- You want an affordable psychiatric evaluation or standard medication such as an antidepressant.
- You haven’t yet tried first-line treatment.
- You want to pay per visit, with prices shown upfront.
- You want therapy or couples therapy.
Choose Better U if…
- You’re an adult whose depression, anxiety or PTSD hasn’t improved with standard medication and therapy.
- You want a structured ketamine program with integration coaching at home.
- You pass Better U’s screening and live in a state it serves.
Read the full reviews
- Sesame Care ReviewA cash-price healthcare marketplace where you book therapists, psychiatric clinicians and doctors directly. Mental health visits start around $34, and ongoing medication care costs $79 a month. No insurance needed; no controlled substances.
- Better U ReviewA telehealth program that prescribes oral ketamine for use at home, with clinician oversight and integration coaching, for about $76–$100 a session. Off-label, self-pay and not for everyone.
More provider comparisons
- BetterHelp vs. SesameA weekly therapy subscription versus a cash-price marketplace for therapy, psychiatry and refills. How BetterHelp and Sesame compare on cost, choice of clinician and medication.
- Talkspace vs. SesameBoth offer online therapy and psychiatry with non-controlled prescriptions. The difference is how you pay — Talkspace through insurance or a weekly plan, Sesame per visit at an upfront cash price.
- PlushCare vs. SesameBoth offer online therapy and non-controlled prescriptions by video. PlushCare takes insurance; Sesame shows upfront cash prices and lets you choose your clinician.
- Sesame vs. LemonaidTwo low-cost, no-insurance ways to get non-controlled mental health medication online. Sesame’s $79 plan lets you pick your prescriber; Lemonaid’s $95 plan includes delivery and a $25 first month.
- Talkspace vs. Better UTalkspace offers first-line care — therapy and psychiatry, often covered by insurance. Better U offers off-label at-home ketamine for treatment-resistant symptoms, self-pay. Here’s who each is for.
- BetterHelp vs. Better UBetterHelp offers first-line talk therapy by subscription; Better U offers off-label at-home ketamine for depression, anxiety or PTSD that hasn’t responded to standard treatment.
When to seek professional help
Consider talking with a doctor or licensed mental health professional if symptomslast for more than two weeks, keep coming back, or make it harder to manage work, school, relationships or daily tasks. You don’t need to wait until things feel severe — getting support early often makes things easier.
If you’re thinking about harming yourself or are in immediate danger, call your local emergency number. In the US, call or text 988 (Suicide & Crisis Lifeline).Crisis resources in other countries.
Explore care optionsFrequently asked questions
Is Sesame or Better U cheaper?
Can Sesame prescribe ketamine?
References
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About this article
Written by
ExploreMentalHealth Editorial Team
Our editors research and write every article using government health agencies, professional medical organizations and peer-reviewed research, following our published editorial standards.
- First published
- September 27, 2026
- Last updated
- September 27, 2026
- Last medically reviewed
- Review pending