Spravato: the complete guide
Adults with treatment-resistant depression can receive Spravato (esketamine) nasal spray, approved in 2019, and in 2020 for major depression with acute suicidal thoughts. Most plans still want an oral antidepressant alongside it. The first month is 8 clinic visits. With commercial insurance you typically pay $10 to $250 per session, and cash prices run $850 to $1,500.
Updated · Checked by the Covered Mind editorial team against cited sources
What Spravato is, who qualifies, what a session is like, how insurance approves it, what it costs, and what the evidence shows.
Key facts
- Last checked:
- Sources listed: 2
- Reading time: About 3 minutes
- Weeks 1 to 4: two sessions per week (8 sessions)
- Commercial insurance: $10 to $250 per session
- Cash price: $850 to $1,500 per session
- Observation: two hours
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 2 |
| Reading time | About 3 minutes |
| Weeks 1 to 4 | two sessions per week (8 sessions) |
| Commercial insurance | $10 to $250 per session |
| Cash price | $850 to $1,500 per session |
| Observation | two hours |
What it is
Spravato is esketamine, one half of the ketamine molecule, delivered as a nasal spray. The FDA approved it in 2019 for treatment-resistant depression in adults, and in 2020 for major depression with acute suicidal thoughts or behavior. In 2025 the label expanded to allow use on its own, although most insurers still require an oral antidepressant alongside it. Check your plan in the coverage checker and read Spravato coverage by insurer. See the Spravato overview for the treatment schedule and answers to common questions.
It is the only ketamine-based treatment covered by insurance, because it is the only one with an FDA label for depression.
Compare visit length and side effects in Spravato vs TMS: how to choose. Read Ketamine vs esketamine: how they differ and Spravato vs ketamine: which is right for you?
Who qualifies
The label and most insurance policies agree on the core criteria:
- A diagnosis of major depressive disorder.
- At least two antidepressants tried in the current episode at an adequate dose for at least six weeks without adequate response.
- Currently taking an oral antidepressant.
- No uncontrolled high blood pressure, aneurysm, or history of intracerebral hemorrhage.
- Not pregnant.
Bipolar depression, psychosis and active substance use disorder are exclusions under most plans even when a clinician would consider treatment.
Read Spravato for treatment-resistant depression, Spravato for depression and Spravato for bipolar depression.
What a session is like
You arrive having not eaten for two hours and not had liquids for 30 minutes. Blood pressure is checked. You self-administer the spray (one device for 56 mg, two for 84 mg) under supervision, then sit in a reclining chair for two hours. Most people feel dissociation, a floaty or detached sensation, for 40 to 60 minutes. Nausea and sedation are common. Blood pressure is rechecked at 40 minutes and before you leave.
You cannot drive until the next day after a full night's sleep. Arrange a ride.
Read What to expect at your first Spravato session.
Schedule
| Phase | Visits |
|---|---|
| Weeks 1 to 4 | two sessions per week (8 sessions) |
| Weeks 5 to 8 | one session per week |
| Week 9 onward | one session every week or every other week, based on response |
Each session is billed as a separate visit, which is why the first month is the most expensive.
Read Maintenance for Spravato, ketamine and TMS.
Insurance
Spravato is a medical benefit, not a pharmacy benefit. The clinic buys the drug, administers it, and bills your plan for the drug and the observation time. Prior authorization is required by almost every commercial and Medicare Advantage plan. Original Medicare has no prior authorization but the clinic must document the label criteria. See the coverage hub for your insurer's rules. Read Does Medicare cover Spravato, and how much will I pay?
Cost
| Who pays | What you pay |
|---|---|
| Commercial insurance | $10 to $250 per session depending on your deductible and coinsurance |
| Savings program | $10 for eligible commercial plans |
| Original Medicare | 20 percent of the allowed amount, about $220 per session, unless a Medigap plan covers it |
| Cash | $850 to $1,500 per session |
See the Spravato cost page.
What did Spravato trials find?
In the pivotal trials, about half of patients responded (a 50 percent drop in symptoms) within four weeks, compared with roughly a third on placebo spray plus an oral antidepressant. The maintenance trial showed that stopping Spravato after remission roughly doubled the relapse rate over the following months. Real-world registries report similar response rates.
Questions to ask a clinic
- Is the clinic REMS certified? (It must be.)
- Does it bill G2082 and G2083, or the drug separately?
- What is the first-month out-of-pocket estimate for my plan?
- What are the hours, and can I do the two-hour observation in the evening?
Read Questions to ask a Spravato, ketamine or TMS clinic.
Read Medicaid coverage for Spravato, ketamine and TMS: state by state overview.
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "Spravato: the complete guide." https://www.coveredmind.com/guides/spravato-complete-guide. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.