Spravato is one of the more affordable innovative treatments for depression, with coverage by insurance and support through its savings programme. This article explains how Spravato insurance coverage works, what you might pay out of pocket, and how the treatment savings programmes can significantly reduce overall costs.

What Is Spravato?

Spravato (esketamine) is a prescription nasal spray based on ketamine. It is made up of one of the two mirror-image molecules that make up ketamine in a mixture.

Spravato was developed by the pharmaceutical company Johnson & Johnson as a treatment for severe depression. Unlike ketamine, it has been approved by the U.S. Food & Drug Administration (FDA), specifically for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI).

FDA approval demonstrates that a medication has been scientifically proven to be safe and effective for a specific condition. This approval is recognized by most insurance companies, who will cover the costs of Spravato if patients meet the clinical criteria.

However, just because the cost of a medication is covered doesn’t mean it’s free. This is where the Spravato savings program comes in. At Emerge, our clinical team is here to help you understand these programs and how to make best use of the financial support available.

So What Will Spravato Cost Me?

Even with insurance, you’ll still have some personal costs to pay for Spravato. These out-of-pocket costs come in a few forms:

• Co-pay: A flat fee you pay per visit to our clinic.
• Co-insurance: A percentage you pay of the total cost, for instance, insurance pays 80%, you pay 20%. These percentages will depend on your specific treatment plan.
• Deductible: An amount you have to spend yourself each year before your insurance starts pitching in.

The SPRAVATO withMe Savings Programs

Johnson & Johnson offers two separate savings programs under the SPRAVATO withMe umbrella. Together, they cover both the medication cost and the clinic monitoring cost of your treatment sessions.

1. The Savings Program (Covers the Cost of the Medication)

This is the main program designed to reduce what you pay for the Spravato medication itself.

What it offers:

Eligible patients pay just $10 per treatment session for the medication. Johnson & Johnson covers the rest of your out-of-pocket share, whether that’s your co-pay, co-insurance, or deductible. There is an annual maximum benefit, meaning the program has a cap on how much it will pay out in a calendar year, but for most patients on a standard treatment schedule, the $10 per session rate holds.

Who qualifies:

• Must be age 18 or older
• Must have commercial or private health insurance
• Insurance plan must still have out-of-pocket costs for Spravato, if your plan already covers 100% of the cost, you’re not eligible
• Not eligible if you use Medicare, Medicaid, TRICARE, VA, or other government-funded healthcare programs

How it works:

Before your first treatment session, you’ll enroll onto the program by visiting SPRAVATOwithMePatientAuth.com. Once enrolled, you receive a savings program card. After each treatment, you’ll submit a rebate request, which you can do with the help from one of our team members at Emerge. This is a simple form along with proof that you paid your out-of-pocket share. A rebate check (a reimbursement payment) is typically mailed to you within about three weeks.

2. The Observation Rebate Program (Covers the Monitoring Cost)

Patients undergoing Spravato treatment must remain in the clinic for two hours after dosing to ensure their safety. The Observation Rebate Program helps cover the costs of this monitoring period.

What it offers

Eligible commercially insured patients pay $0 out of pocket for the observation portion of each treatment after submitting a rebate request.

Who qualifies

The eligibility requirements are the same as the Savings Program. However, this program is not available to residents of Massachusetts, Minnesota, or Rhode Island meaning you can’t access this savings program at Emerge. However, our clinical costs are very well priced.

How to use it: You enroll in this program at the same time as the Savings Program. After each session, you submit a separate rebate request form with proof of payment for your monitoring costs. The reimbursement check arrives in about three weeks.

How to Get Started

Here’s a straightforward path to accessing these savings:

1. Talk to one of the clinical team members at Emerge about whether Spravato is right for you. You’ll need documentation from your doctor to show that you’re eligible for reimbursement.
2. Confirm your insurance coverage. We can help with this step, verifying your benefits before your first appointment.
3. Enroll in the SPRAVATO withMe programs before your first treatment session. You can do this at SPRAVATOwithMePatientAuth.com.
4. Submit your rebate requests after each treatment. Our team may be able to do this on your behalf.

Get Help with Savings Support at Emerge

At Emerge, our clinical team is here to help you access the most affordable depression treatment and will guide you through each step of the process to access savings support.

If you’d like to learn more about our Spravato treatment program and whether you’re eligible, get in touch with one of our team members today.