If you’ve been struggling with treatment-resistant depression and your doctor has mentioned Spravato (esketamine), one of your first questions is probably about cost. Spravato is one of the newer FDA-approved treatments for depression, and like many newer medications, it comes with a price tag that makes insurance coverage a very real concern. The short answer is: yes, Spravato can be covered by insurance — but the path to getting that coverage approved takes some preparation and patience.
Here’s what you need to know.
Spravato is a nasal spray form of esketamine, a drug closely related to ketamine. The FDA approved it in 2019 specifically for adults with treatment-resistant depression — meaning depression that hasn’t responded adequately to at least two antidepressant treatments. It’s also approved for adults with major depressive disorder who are experiencing active suicidal ideation with intent. In 2025, however, the approval was expanded to be used in adults without a concurrent oral antidepressant (so you have to have tried medication for depression in the past, but you do not need to be currently taking medication for depression to have insurance coverage for Spravato).
Unlike traditional antidepressants you take at home, Spravato must be administered in a certified healthcare setting, where patients are monitored for at least two hours after each dose. This in-office requirement is one of the reasons the cost can add up quickly. A single session can cost several hundred dollars, and a full course of treatment typically involves multiple sessions per week over several weeks.
Many major insurance plans do cover Spravato, but coverage is rarely automatic. Most insurers classify it as a specialty medication and require patients to meet specific criteria before approving it. Here’s a general breakdown of coverage by plan type:
Commercial Insurance Plans Most major commercial insurers — including Aetna, Cigna, United Healthcare, and Blue Cross Blue Shield — have established coverage policies for Spravato. However, prior authorization is almost always required. Insurers want documentation showing that you’ve already tried and failed to respond to other depression treatments before they’ll agree to pay for Spravato.
Tricare and VA If you are an active-duty service member, veteran, or dependent covered under Tricare or the ChampVA, coverage for Spravato may be available, though it depends on your specific plan and the clinical setting where treatment is administered.
Prior authorization for Spravato almost always means demonstrating treatment-resistant depression. Insurers generally want to see:
If your insurer denies coverage initially, an appeal — especially one supported by your doctor’s clinical documentation — can often result in approval.
At Advantage TMS we handle the entire insurance prior authorization process for you!
If your insurance denies coverage or you don’t have insurance, there are still options worth exploring.
Janssen’s Patient Assistance Program Janssen, the manufacturer of Spravato, offers a patient assistance program for those who qualify based on income and insurance status. They also have a co-pay assistance program that can significantly reduce out-of-pocket costs for commercially insured patients who meet eligibility requirements.
Appeals A denial is not the end of the road. Advantage TMS almost always is successful at appealing insurance denials.
Exploring Alternatives For some patients, the insurance hurdles around Spravato can feel overwhelming — especially when depression is already making everything harder. It’s worth knowing that other effective, insurance-covered treatments exist for treatment-resistant depression.
At Advantage TMS we handle all prior authorizations, patient assistance paperwork and any appeals!
At Advantage TMS, we offer both Spravato and Transcranial Magnetic Stimulation (TMS) therapy — giving patients who haven’t found relief from antidepressant medications more than one path forward.
TMS therapy has strong insurance coverage across many major plans, including Tricare, Champ VA, Medicare, Aetna, Cigna, United Healthcare, and all Blue Cross Blue Shield plans. Like Spravato, it’s designed for patients with treatment-resistant depression. It works by using magnetic pulses to stimulate the areas of the brain responsible for mood regulation — non-invasively, without medication, and without the systemic side effects that can come with drugs.
Our team works with patients to verify their insurance benefits and help them understand what’s covered before treatment begins. With a board-certified psychiatrist and a Licensed Clinical Social Worker on staff, our program pairs TMS with cognitive behavioral therapy and personalized lifestyle support — giving patients a comprehensive approach to recovery.
TMS sessions are about 20 minutes long, you can drive yourself to and from appointments, and you can return to your normal day immediately afterward. We’re open Monday through Saturday with extended hours to make treatment as accessible as possible.
Spravato can be covered by insurance, but it takes documentation, prior authorization, and often some persistence to get there. At Advantage TMS, our team is here to help you navigate that process and explore all of your treatment options — including TMS therapy, which is covered by many major insurance plans.
Contact Advantage TMS today to schedule a free consultation and find out which treatment is right for you.
Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant. P & T : a peer-reviewed journal for formulary management, 44(6), 340–375.
Our office is closed December 25th for Christmas and January 1st for New Years Day. If you have any questions or urgent requests, please email us at info@advantagementalhealth.com.
Please fill out the form if you have a patient interested in learning more about TMS treatment. We appreciate the referral and partnership.
Next Steps:
• Our TMS Coordinator will contact the patient to schedule a complimentary information session.
• If the patient decides to seek TMS treatment with Advantage TMS, we will communicate with you when necessary and the patient will continue to work with you while receiving treatment.
Questions?
• Please don’t hesitate to contact us at 727-600-8093 or info@advantagementalhealth.com
