One of the most common questions about Spravato isn’t whether it works — it’s whether insurance will cover it.

The answer is often yes — but coverage depends on your diagnosis, documentation, and your specific insurance plan.

Understanding how insurance works for Spravato can make the process far less confusing.

Spravato (esketamine) is FDA-approved for:

• Treatment-resistant depression
• Major depressive disorder with acute suicidal ideation or behavior

Because it’s FDA-approved and administered in a REMS-certified medical setting, many insurance plans cover Spravato when eligibility criteria are met.

This is an important distinction. Unlike IV ketamine (which is often considered off-label and may not be reimbursed), Spravato has formal FDA approval for specific diagnoses, which makes insurance coverage more likely.

Insurance coverage usually depends on documentation showing:

• A diagnosis of major depressive disorder
• At least two prior antidepressant trials
• Inadequate response or intolerance to those medications
• Treatment provided in a certified Spravato (REMS) clinic

This is why reviewing your medication history is a critical part of the evaluation process.

Therapeutic Infusions works with many major insurance providers, including:

• Aetna
• AmeriHealth (commercial plans only)
• Ambetter Health
• Delaware First Health
• Cigna
• Highmark Health Options
• Highmark Blue Cross Blue Shield
• Independence Blue Cross (IBX)
• Medicare
• Medicaid
• MultiPlan
• UnitedHealthcare (UHC)
• WellCare Medicaid – DE

If your insurance provider isn’t listed, it doesn’t automatically mean coverage isn’t possible. Verification is always the first step.

For the most current info about our clinic and insurance, see: Insurance Plans Accepted at Therapeutic Infusions

Most plans require prior authorization before Spravato treatment begins.

Prior authorization means your provider submits documentation to confirm:

• Medical necessity
• Diagnosis and treatment history
• That treatment will occur in a certified clinical setting

At Therapeutic Infusions, the team:

• Verifies your insurance benefits
• Clarifies what your plan covers
• Assists with prior authorization paperwork
• Communicates directly with insurers when needed

Delays during prior authorization are common and administrative — not a judgment about your condition.

Even when insurance covers Spravato, patients may still have:

• Copays for office visits
• Coinsurance
• Deductibles

Because Spravato is administered in a medical setting, billing typically includes both:

• The medication
• The supervised treatment visit

The exact amount depends on your plan’s structure.

For services not covered by insurance, Therapeutic Infusions offers transparent pricing and accepts HSA/FSA cards. Flexible payment options may also be available.

Mental health coverage can vary significantly by insurer and diagnosis.

Spravato is often covered because it is FDA-approved for specific indications. However, innovative or emerging treatments — such as IV ketamine infusions or ketamine-assisted psychotherapy — may be considered off-label and not reimbursed.

Coverage decisions are typically based on:

• Diagnosis
• Treatment history
• Plan details
• Medical necessity

This is why individualized verification matters.

Denials can happen for reasons such as:

• Incomplete documentation
• Missing prior medication history
• Administrative errors

In many cases, additional documentation or an appeal can resolve the issue.

Sometimes, eligibility becomes clearer after further review or updated clinical documentation.

If you’re considering Spravato and wondering about insurance coverage, the first step is a clinical evaluation — not guessing based on your policy alone.

During your initial consultation, the team can:

• Review your medication history
• Determine whether you meet eligibility criteria
• Verify your insurance benefits
• Explain what your plan covers
• Guide you through prior authorization if needed

Insurance can feel complicated, but you don’t have to navigate it alone.

You can learn more about Spravato treatment and how coverage is handled at Therapeutic Infusions on our Spravato treatment page.