Ketamine vs SSRIs: Cost and Insurance Comparison
Which depression treatment is easier on your wallet?
This chart breaks down out-of-pocket costs for insured and uninsured patients, detailing coverage under self-pay, commercial insurance, Medicare, and Medicaid. While ketamine therapy is generally far more expensive than SSRIs, if you have commercial insurance that partially covers the nasal spray Spravato, Johnson & Johnson’s subsidy can actually make it cheaper than SSRIs.
Note: Despite research showing that IV drips and injections often provide faster, more effective relief (you can see it here, here and here), the FDA has approved only one method of administration: Johnson & Johnson’s nasal spray, Spravato.
It’s like having a toolbox but only being allowed to use the smallest wrench. It doesn’t make much sense but the FDA has restricted its approval to the “wrench”—Spravato—while ignoring IV drips and injections, which could deliver the same relief more effectively.
Without FDA approval, insurance companies won’t cover these proven alternatives, leaving many patients without access to better, more affordable options. Now, why would the FDA limit life-changing treatments to just one tool when others are clearly available? Find out in my article, Why the FDA Approved a Nasal Spray and But Not IV Infusions and Injections.
Click here for a more detailed table on ketamine costs and insurance coverage.
Ketamine vs. SSRIs: A Side-by-Side Look at Costs and Coverage
| ASPECT | Ketamine Therapy | SSRIs |
|---|---|---|
| 100% Self Pay |
Spravato Nasal Spray $1,000 - $1,500 per treatment. 3-month protocol (14 treatments): $14,000 to $21,000 IV Infusion $400 to $800 per treatment 3-month protocol (6-14 treatments): $2,400 to $11,200 Injection $275 to $400 per session 3-month protocol (6-14 treatments): $1,650 to $5,600 |
Generic SSRIs annually: Up to $750
Brand Name SSRIs annually: Up to $5,000
New Brand Name SSRIs annually: Up to $9,000 |
| COMMERCIAL INSURANCE COVERAGE |
Spravato Nasal Spray Spravato is the only form of ketamine therapy covered by insurance; IV infusions and injections are not covered. ALMOST ZERO COST WITH SPRAVATO SUBSIDY With commercial insurance, Johnson & Johnson's subsidy program of $8,150 allows eligible patients to pay as little as $10 per Spravato treatment, making a three-month protocol of 16 treatments cost approximately $160. WITHOUT SUBSIDY Most insurers will cover about 50% of Spravato costs; some will cover more depending on the plan. Your out-of-pocket costs would be about $500-$600 per treatment.
3-month protocol (14 treatments) costs: Over $8,000
|
Generic Covers up to 80% or more Co-pays average $10-$50/month Typical annual out-of-pocket costs: $750
Established Brand Names (example: Zoloft) Often no coverage if there are generic equivalents Covers 30-50% of the drug's cost Co-pays average $30-$75/month Often requires prior authorization Typical annual out-of-pocket costs: $3,500
New Brand Name Drugs Recently Come To Market (example Exxua) Not typically covered at all Self-pay: Self-pay costs range from around $500 to several thousand dollars per month, depending on the treatment. Typical annual out-of-pocket costs: $7,500
Insurance Out-of Pocket-Costs Generic SSRIs annually: $180 Brand Name SSRIs annually: $3,300 New Brand Name SSRIs annually: $7,500 |
| MEDICARE COVERAGE |
Spravato Nasal Spray Spravato is the only form of ketamine therapy covered by Medicare; IV infusions and injections are not covered.
Medicare Part B covers 80% of Spravato
Some Medicare Advantage plans pay nearly 100% of the costs.
No Johnson & Johnson Subsidy Patients on Medicare are not eligible for Johnson & Johnson’s $8,150 Spravato subsidy program. |
Generic Drugs The cost-sharing structure (deductibles, copayments) for generic SSRIs under Medicare Part D is comparable to that of commercial insurance plans. However, specific out-of-pocket costs will depend on the individual plan's formulary and tier system.
Established Brand Name Drugs Costs for brand-name SSRIs under Medicare and commercial insurance are often about the same, but this can vary based on individual circumstances.
New Brand Name Drugs Generally speaking, it's more expensive to get new brand-name SSRIs through Medicare compared to commercial insurance. |
| MEDICAID COVERAGE |
Spravato Nasal Spray Spravato is the only form of ketamine therapy covered by Medicaid; IV infusions and injections are not covered.
Medicaid coverage for Spravato is typically less comprehensive than Medicare, often leaving you with higher out-of-pocket costs.
No Johnson & Johnson Subsidy
Patients on Medicaid are not eligible for Johnson & Johnson’s $8,150 Spravato subsidy program.
|
Generic Drugs
Generally, Medicaid tends to offer lower out-of-pocket costs for generic medications compared to commercial insurance.
Established Brand Name Drugs
Medicaid covers brand-name drugs and typically offers lower out-of-pocket costs compared to commercial insurance, but there are substantial variations depending on state policies and plan details.
New Brand Name Drugs
Medicaid covers new brand-name drugs like Exxua and typically offers lower out-of-pocket costs compared to commercial insurance, but there are substantial variations depending on state policies and plan details. |