Why Some Patients Are Denied Spravato And What to Do Next

Being told you don’t qualify for Spravato — or that insurance won’t approve it — can feel like hitting a wall, especially after years of trying different treatments.

In most cases, a Spravato denial isn’t a judgment about whether your depression is “bad enough.” It’s usually about timing, documentation, or safety considerations. Understanding why denials happen can make the next steps much clearer.

One of the most common reasons patients are denied Spravato is a lack of documented antidepressant trials.

Spravato is approved for treatment-resistant depression, which typically requires evidence that at least two antidepressants were tried at appropriate doses and durations. If treatment history is incomplete — or scattered across multiple providers — it can be harder to demonstrate eligibility right away.

This doesn’t mean Spravato is off the table. In many cases, providers can help gather records or clarify medication history so eligibility can be reassessed.

Another frequent issue is timing.

Insurance reviewers often look for confirmation that medications were taken long enough to evaluate effectiveness. If antidepressants were stopped very early, even for valid reasons, they may not immediately count toward treatment resistance.

Side effects, dose changes, or inconsistent use can complicate this process — but they don’t automatically disqualify someone. These situations usually require more careful clinical review, not dismissal.

Spravato affects blood pressure and can cause dissociation, which is why it’s administered under medical supervision.

Patients may be denied or delayed if there are concerns such as:

• Poorly controlled high blood pressure
• Certain heart conditions
• Neurological issues that require further evaluation
• Active substance misuse that hasn’t been addressed

In these cases, denial is about safety, not effectiveness. Sometimes eligibility can change once medical conditions are better managed.

Spravato must be administered in a REMS-certified clinic with on-site monitoring. Patients who cannot stay for observation or don’t have access to a certified treatment center may be temporarily ineligible.

This is a regulatory requirement, not a reflection of whether Spravato could help.

It’s also important to distinguish between clinical eligibility and insurance approval .

A provider may determine that Spravato is medically appropriate, while insurance requires additional documentation or prior authorization. Delays and denials at this stage are common and often administrative.

In many cases, appeals or additional paperwork can resolve the issue.

A denial doesn’t mean you’re out of options. Next steps may include:

• Reviewing medication history in more detail
• Completing additional antidepressant trials if appropriate
• Addressing medical factors that affect safety
• Appealing an insurance decision with supporting documentation
• Exploring alternative treatments while eligibility evolves

For some patients, denial is temporary. For others, it helps clarify which treatment path makes the most sense right now.

If Spravato isn’t approved — or isn’t the right fit — it doesn’t mean progress stops.

Depending on your situation, alternatives may include:

• IV ketamine therapy
• Adjustments to psychiatric medications
• Combination or augmentation strategies
• Psychotherapy integrated with medication changes

A thoughtful treatment plan looks at what will be most effective and safest, not just what was originally hoped for.

One of the hardest parts of a Spravato denial is the emotional impact. Many patients interpret it as a message that they haven’t tried hard enough or that their depression doesn’t “qualify.”

That isn’t how the process works.

Eligibility decisions are based on criteria, documentation, and safety — not on how real or valid someone’s experience is. With the right guidance, many patients find a path forward, whether that includes Spravato now or another option that better fits their needs.

If you’re navigating Spravato eligibility or have been told you don’t qualify yet, a clinical evaluation can help clarify why — and what comes next.

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