Spravato insurance coverage is a common concern for patients considering this breakthrough treatment for depression. Spravato (esketamine) offers new hope for individuals with treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). While the treatment can be life-changing, it’s also a financial commitment. This article explains how insurance coverage works and what you can expect at Emerge Ketamine in Boston.
What Is Spravato?
Spravato is a prescription nasal spray containing esketamine, which is a compound derived from ketamine. Janssen Pharmaceuticals developed Spravato specifically for treating depression. The FDA approved Spravato for treatment-resistant depression (TRD) in 2019 and major depressive disorder with suicidality (MDSI) one year later.
Whereas classical antidepressants interact with serotonin, Spravato interacts with another chemical messenger in the brain called glutamate. By blocking NMDA receptors—a type of protein—Spravato increases the signaling of glutamate, which increases activity in areas of the brain that are underactive in depression. Glutamate also promotes neuroplasticity, the brain’s ability to grow and reorganise. Neuroplasticity helps strengthen nerve circuits involved in emotional regulation.
What Does Spravato Treatment Look Like?
Spravato treatment must adhere to a standard protocol as outlined in FDA guidelines. Our clinics in Woburn and Danvers are certified Spravato treatment centres, and we strictly follow these guidelines to ensure your safety and well-being. Here’s what you can expect from our services.
Treatment Session
Spravato is self-administered as a nasal spray under direct medical supervision. You’ll be given a private, comfortable room where you’ll take the prescribed number of sprays. Our staff will monitor you for at least two hours afterwards to ensure that any side effects have worn off and you are safe to leave.
Treatment Schedule
During the first four weeks, you’ll come to the clinic twice per week. Following this induction phase, treatment is continued on a less frequent basis. From week 5 through week 8, most patients visit once a week. Starting around week 9, sessions typically occur every other week, although the exact schedule may be adjusted depending on your progress and needs.
How Much Does Spravato Cost?
Without insurance, each dose of Spravato can cost between $600 and $800, which can mean the overall treatment is very expensive. Fortunately, insurance often covers Spravato, depending on your provider and whether you meet the eligibility criteria.
While the medication costs are often covered, patients are still expected to pay copays and deductibles, which will vary depending on the specific insurance plan. Other out-of-pocket costs may include pre-treatment evaluations and clinical follow-ups.
What Insurance Covers Spravato in Massachusetts?
Most major insurers in Massachusetts cover Spravato. This includes:
- Aetna
- Cigna
- BCBS of Mass
- Humana
- Mass Health
- Medicare
- Medicaid
While Emerge does not bill insurance directly, we’ll help you navigate Spravato insurance coverage by providing all the necessary paperwork.
Am I Eligible for Spravato Insurance?
To determine your Spravato insurance coverage, your provider will submit prior authorization paperwork outlining your diagnosis and history.
To be diagnosed with TRD, you’ll have tried at least two different types of antidepressants for at least six months each with no significant benefits. For MDSI, you’ll have a clinical diagnosis of MDD, without psychotic features, and be deemed to be at risk of suicide by a registered clinician.
Other requirements for Spravato include:
- You must be over 18
- You must take an antidepressant alongside Spravato
- No present or history of certain medical conditions, including vascular disease
- You don’t use intravenous ketamine
If you’re unsure about your eligibility, you can schedule a complimentary consultation with our staff to determine if Spravato is right for you. Our team is also here to help you navigate the authorization process, making your road to recovery as simple as possible.
Factors That Can Impact Your Out-of-Pocket Costs
Several variables can influence your final cost for Spravato treatment. These include:
- Insurance Type – Coverage can vary depending on your provider and specific plan
- Deductibles & Co-Pays – Your plan may require you to pay a certain amount before coverage begins, and there may be per-visit co-pays.
- Clinic Monitoring Fees – Spravato must be administered under medical supervision, and this time is billable to insurance.
- Treatment Duration – Some patients may transition to less frequent dosing over time, while others may require a longer course.
If you have questions about Spravato insurance coverage, schedule a consultation with our team at Emerge.
Key Takeaways
- Spravato is a fast-acting, FDA-approved treatment for TRD and MDSI.
- Emerge Ketamine in Boston is a leading provider of Spravato and can help navigate insurance and understand costs.
- Costs vary depending on your insurance plan and unique needs
- If you’re unsure whether your plan includes Spravato coverage, our team will help you find out.