Spravato: the complete guide

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. See the Spravato hub, the coverage hub, the coverage checker, treatment comparisons and condition and treatment pages.

It is the only ketamine-based treatment covered by insurance, because it is the only one with an FDA label for depression.

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.

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.

Schedule

• 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.

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.

Cost

With commercial insurance, the range is $10 to $250 per session depending on your deductible and coinsurance; the manufacturer's savings program can bring the copay to $10 for eligible commercial plans. With Original Medicare you pay 20 percent of the allowed amount, about $220 per session, unless a Medigap plan covers it. Without insurance the cash price runs $850 to $1,500 per session. See the Spravato cost page.

Evidence

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?