Is Ketamine Therapy Covered by Insurance?
This page explains which types of ketamine therapy are covered by insurance, why only Spravato (esketamine nasal spray) is reimbursed, and how your out-of-pocket costs vary based on plan type, deductible, and billing model. It covers IV, injection, and oral ketamine as off-label methods and includes detailed per-session and full-course estimates for Spravato treatment.
Insurance only covers one kind of ketamine therapy: the Spravato nasal spray. It doesn’t cover IV infusions, intramuscular injections, or oral lozenges, even though those forms have been studied far more extensively and shown to be safe and effective.
Why? Two words: FDA approval. Spravato is the only formulation that’s been officially approved for depression. Without that approval, other forms of ketamine are considered “off-label” so insurers refuse to cover them.
The irony? According to the Mayo Clinic, 21% of the drugs insurance companies cover are prescribed off-label. That includes treatments for cancer, epilepsy, heart disease, and major depression. Off-label use is standard practice. But when it comes to ketamine, insurers won’t budge.
Since no other form of ketamine therapy is covered by insurance, the rest of this guide will walk you through what Spravato actually costs—session by session, plan by plan—so you can estimate your real out-of-pocket total before starting treatment.
Table of Contents
- The Median Out-of-Pocket Cost for Each Session of Spravato
- The Total Out-of-Pocket Cost for a Full Course of Spravato
- FAQs
- A Session-by-Session Look at What You’ll Actually Pay with Insurance
- Total Out-of-Pocket Costs by Plan and Billing Model
- Total Out-of-Pocket Cost (21 Sessions) — “Specialty Pharmacy” Model
- Estimated Per-Session Cost (21 Sessions) — “Specialty Pharmacy” Model
- Total Out-of-Pocket Cost (21 Sessions) — “Buy and Bill” Model
- Estimated Per-Session Cost (21 Sessions) — “Buy and Bill” Model
- Key Assumptions Used in These Estimates
- How to Lower Your Spravato Costs with Manufacturer Subsidies
- What You Need to Know About Spravato Costs—At a Glance
- How to Estimate Your Out-of-Pocket Costs (Step-by-Step)
The Median Out-of-Pocket Cost for Spravato
It’s about $250 per session, spread across the full 21-session protocol.
That number is accurate—but it can be misleading. It doesn’t mean you’ll pay $250 for each visit. Costs are front-loaded. If you haven’t met your deductible, your first few sessions could cost over $1,800 each. For example, if you’re on a high-deductible plan, you might pay $5,000 or more in your first month alone. But once you hit your deductible and your out-of-pocket max, everything changes. Your later sessions might cost $30—or even nothing at all.
It averages out to $250 over time. That’s the dollar-cost average across all 21 sessions.
But not everyone lands at $250. Some people pay less. Others pay a lot more. It depends on how your plan is structured and where you are in your coverage year. Your cost is shaped by:
- How high your deductible is—and how much of it you’ve already met
- Whether your plan uses a flat copay or a percentage-based coinsurance
- Whether your clinic is classified as a hospital or outpatient office
- How quickly you hit your out-of-pocket maximum
That’s why you’ll hear such wildly different stories from people who’ve done this treatment. One person might say it was affordable. Another might say it nearly bankrupted them. They’re both telling the truth.
What this guide will do is walk you through real numbers—by plan type, by session, and by cost pattern—so you can see where you fall and what to expect.
Takeaway
Even though the average Spravato session costs $250, early treatments can top $1,800 depending on your deductible and plan structure.
The Total Out-of-Pocket Cost for a Full Course of Spravato
For most people, total out-of-pocket costs for completing Spravato’s full FDA-approved treatment protocol—21 sessions over six months—fall somewhere between $2,000 and $9,450. That number climbs if you start the year with your deductible untouched, or if your plan applies coinsurance to high session costs. It shrinks if you’ve already met your deductible, or if your plan uses flat copays.
Your per-session cost won’t be steady. It may start high—$1,800 for the first visit—and drop as insurance begins covering more. For many patients, the first month is the most expensive, and the final few sessions cost almost nothing.
Frequently Asked Questions About Spravato Costs
How many Spravato treatments will I need—and how much will the full course really cost me?
Spravato is delivered on an FDA-approved protocol: twice a week for the first month, once a week for the second month, and once every two weeks for the next four months. That adds up to 21 sessions over six months.
This protocol isn’t a suggestion—it’s the foundation for how Spravato is prescribed, authorized, and covered. Insurance will cover additional sessions if you and your provider determine that extended treatment is medically necessary.
The 21-session model reflects the standard treatment plan approved by the FDA, recognized by insurers, and used by most clinics when scheduling. It’s the number this guide uses to calculate cost—because it’s what most patients can expect to plan for.
Out-of-pocket costs for the full course typically range from $2,000 to $9,450, depending on your deductible, coinsurance, and out-of-pocket maximum. The median cost works out to about $250 per session—but that number is front-loaded. If your deductible hasn’t been met, early sessions may cost over $1,800. Later sessions often drop to $30 or less once you hit your plan’s limits.
What’s the price range for Spravato treatment—and how does your insurance plan shape where you fall?
What you’ll pay out of pocket depends on your insurance plan—especially your deductible, coinsurance, and out-of-pocket maximum.
Here’s the general range:
- Worst case (you haven’t met your deductible): $5,000 to $9,450 total
- Typical case (you’ve met part of your deductible): $3,000 to $6,000 total
- Best case (your deductible and out-of-pocket maximum are already met): $0 to $2,000 total
So why is the range so wide? Because your insurance design—not just your coverage—determines where you fall. High-deductible plans front-load your costs early, often requiring thousands out of pocket before you hit your max. Plans with lower deductibles or flat copays offer more protection but are less common.
Where you are in your coverage year also matters. Someone starting treatment in January might owe nearly every dollar of that $5,000 to $9,000 range. Someone starting in October, after hitting their deductible on other care, might owe far less.
What looks like one treatment path on paper becomes five or six different realities in practice—depending entirely on your plan.
How do deductibles and out-of-pocket maximums affect Spravato costs—and how can I estimate what I’ll actually pay?
Deductibles and out-of-pocket maximums are the two biggest factors that determine what you’ll pay for Spravato.
Your deductible is the amount you have to pay before your insurance starts covering a percentage of the cost. If your deductible is $3,000 and you haven’t used any of it yet, you’ll likely owe full price—around $1,800 per session—until you reach that amount.
After your deductible is met, coinsurance usually kicks in. That means you pay a percentage of the session cost, typically between 20% and 40%. So a session that costs $1,800 might cost you $360 under 20% coinsurance.
Once you’ve spent enough to hit your out-of-pocket maximum, your insurance covers 100% of eligible costs. At that point, you might pay nothing—or just a small copay per session.
To estimate your total cost:
- Find out your deductible, coinsurance, and out-of-pocket max
- Ask your clinic what they charge per session
- Multiply each phase of cost by the number of sessions you expect to have
If the clinic won’t tell me what insurance will cover—and the insurer won’t either—how do I find out the cost of Spravato or plan ahead anyway?
This is one of the most frustrating parts of starting Spravato: no one will give you a clear number. The clinic says it depends on insurance. The insurer says it depends on the provider. And you’re stuck trying to plan for something you can’t price.
If that’s where you are, here’s how to move forward:
- Find out your deductible, coinsurance rate, and out-of-pocket maximum
- Ask the clinic what they charge per session
- Use averages: If the session cost is $1,800 and you haven’t met your deductible, you’ll likely owe that up front. After that, expect to pay 20% to 40% until you reach your plan’s max
You may not get certainty—but you can still build a smart estimate. That’s the best protection you have.
What if I can’t afford my out-of-pocket costs for Spravato—can I get financial help, and how much?
If you’re approved for Spravato but can’t afford your share of the cost, there may be help available—but it depends on your insurance type and income level.
For people with commercial insurance, Janssen (the drug’s manufacturer) offers a copay assistance program that may reduce your cost to as little as $10 per session. It only applies if your insurance already covers Spravato. It does not work for government plans like Medicare or Medicaid, and it doesn’t cover people paying cash.
If you’re uninsured or your insurance denies coverage, you won’t qualify for manufacturer assistance—but some clinics offer internal discounts or payment plans. A few nonprofits also provide grants for treatment-resistant depression, though they’re hard to secure.
If you’re on Medicare or Medicaid, there’s no manufacturer assistance—but your costs may already be low. Medicaid often limits copays to $0–$10. Medicare may reduce costs through supplemental coverage like Medigap or Medicare Advantage.
No matter your plan, ask the clinic’s billing team if they can help you explore all available options before starting treatment.
Does Medicare or Medicaid cover ketamine therapy—and which forms (IV, injection, oral, or Spravato) are usually covered?
Only one form of ketamine therapy is covered by Medicare or Medicaid: Spravato, the esketamine nasal spray. The other types—IV infusions, intramuscular injections, and oral lozenges—are considered off-label and are not covered by either program.
Medicare Part B generally covers Spravato because it’s a physician-administered treatment that requires monitoring in a certified facility. Coverage includes the cost of the drug, the two-hour observation period, and related clinic services. You’ll still owe the annual Part B deductible (about $257 in 2025) and 20% coinsurance after that—unless you have a supplemental plan like Medigap or Medicare Advantage.
Medicaid also covers Spravato in many states, but the rules vary. Some states fully cover it, while others don’t cover it at all. When it is covered, out-of-pocket costs are usually minimal—often just $0 to $10 per visit. Medicaid may also cover the facility fee and even transportation.
Coverage may differ for people who are dual-eligible for both Medicare and Medicaid. Always ask the clinic to verify your benefits before starting.
A Session-by-Session Look at What You’ll Actually Pay with Insurance
Let’s assume you have a $2,000 deductible and you’re starting the first of the year. Here’s how your costs might break down over time:
| Session | You Pay | What’s Happening |
|---|---|---|
| 1 | $1,800 | You’re paying full price. This applies to your deductible. |
| 2 | $200 | This brings you to your $2,000 deductible. |
| 3 | $360 | 20% coinsurance kicks in. Insurance now covers 80%. |
| 4 | $360 | |
| 5 | $360 | |
| 6 | $360 | |
| 7 | $360 | |
| 8 | $360 | |
| 9 | $360 | |
| 10 | $360 | You’ve now paid $5,180 total. |
| 11 | $360 | |
| 12 | $360 | You hit your out-of-pocket max during this session. |
| 13–21 | $30 each | You now pay a flat copay or nothing. Insurance covers the rest. |
Total cost: $6,000. That averages out to about $285 per session.
It’s not exactly $250, but it’s close—and much more typical of what most commercially insured patients will experience. Some plans cover a little more. Some charge more per session up front. But for most PPO plans with modest deductibles and 20% coinsurance, this is the shape of the curve: steep at first, steady in the middle, then a big drop at the end.
And unlike high-deductible plans, you don’t spend three or four sessions paying full freight. You reach your deductible fast, and then insurance starts helping.
Takeaway
The full 21-session Spravato protocol typically costs $6,000 with insurance, averaging $250 per session as early costs drop from $1,800 to $30.
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What Does Spravato Cost with Insurance? Total Out-of-Pocket Costs by Plan and Billing Model
If your insurance covers Spravato, your out-of-pocket cost depends on two major factors:
- your plan’s design (deductible, coinsurance, out-of-pocket max)
- how your insurer chooses to bill the treatment
That second part—billing model—is often overlooked, but it shapes everything: how much you owe, when you owe it, and how many separate bills you’ll receive.
Two Billing Models That Shape Your Costs
Spravato is billed in one of two ways:
- Specialty Pharmacy model (used by 60–70% of insurers): A third-party pharmacy ships the drug to your clinic. You’re billed separately—once for the drug, once for the clinic time.
- Buy and Bill model (used by 30–40% of insurers): The clinic purchases the drug themselves and bills your insurance for the full session—medication plus monitoring—in one combined charge.
You don’t get to choose the model. Your insurer decides. But the model affects everything:
- Whether your deductible applies to the medical benefit, the pharmacy benefit, or both
- Whether you receive one bill or two
- How quickly you reach your out-of-pocket maximum
Most national insurers—like Cigna, UnitedHealthcare (OptumRx), Magellan, and many Blue Cross plans—require the Specialty Pharmacy model. Others, including Aetna, some state-specific Blue Cross plans, and certain PPOs and EPOs, use Buy and Bill.
Why You Need Both Total and Per-Session Estimates
If you’re planning treatment, you probably want to know two things:
- How much will I pay in total?
- How much will each session cost me?
We’ll show you both. First, we break down the total out-of-pocket cost across the full 21-session protocol (FDA-approved induction and maintenance). Then we show how that cost plays out session by session—from the expensive early weeks (when deductibles apply) to the later sessions (when insurance covers most or all of it).
The charts below reflect both billing models—and three cost scenarios for each:
- worst case (you haven’t met your deductible)
- typical case (you’ve met part of it)
- best case (your out-of-pocket max is already met)
Your billing model may be invisible to you—but your cost won’t be. That’s why both versions are included below.
Takeaway
Spravato can be billed two ways—either as one combined session or split into separate charges for the drug and clinic—and that difference directly affects your out-of-pocket cost.
Spravato Total Out-of-Pocket Cost (21 Sessions) — Specialty Pharmacy Billing
The table below shows your estimated out-of-pocket costs for the full FDA-approved Spravato treatment protocol—21 sessions over six months. These estimates reflect the most common billing method used by insurers: the Specialty Pharmacy model.
Each column represents a different type of commercial insurance plan. Each row shows a different coverage scenario—from worst case (you haven’t met your deductible) to best case (you’ve already hit your plan’s out-of-pocket maximum).
These totals include both the cost of the medication and the clinic time required to administer annod monitor each session.
| Cost Scenario | HDHP | PPO | Kaiser Bronze HMO | Kaiser Gold HMO | Non-Kaiser HMO | EPO | Excellent Plan |
|---|---|---|---|---|---|---|---|
| Worst Case | $9,450 | $5,000–$6,000 | $6,000–$8,200 | $2,500–$4,000 | $6,000–$9,450 | $5,000–$8,700 | $630 |
| Typical Case | $6,000–$7,000 | $3,000–$4,000 | $4,000–$5,000 | $1,800–$2,500 | $4,000–$6,000 | $3,500–$5,500 | $630 |
| Best Case | $2,000–$3,000 | $1,000–$2,000 | $1,000–$2,000 | $630–$1,000 | $1,000–$2,000 | $1,000–$2,000 | $630 |
Note: What This Table Means for You
This table shows your estimated out-of-pocket cost per session if you complete all 21 sessions of Spravato under the Specialty Pharmacy billing model.
The cost per session depends heavily on where you are in your insurance cycle:
- Worst case: You haven’t met your deductible, so you’re paying full price until it’s reached.
- Typical case: You’ve met part of your deductible, and are now splitting costs through coinsurance (typically 20–40%).
- Best case: You’ve already hit your out-of-pocket maximum, so insurance covers 100% and your cost drops to zero—or just a small flat copay.
If you’re early in the year or just starting treatment, expect higher costs in the beginning. If you’ve already paid toward your deductible from other care, your per-session cost could be significantly lower. This table gives you a realistic sense of what each appointment might cost you depending on your plan—and when you start.
Per-Session Spravato Cost — Specialty Pharmacy Billing Model
In the table above, you saw what your total out-of-pocket cost would be for completing the full 21-session Spravato treatment protocol—depending on your insurance plan and how much of your deductible or out-of-pocket maximum you’ve met.
But what does that actually look like per visit? The table below breaks it down by session, so you can see how your cost might change across the course of treatment—especially as your deductible is met and coinsurance kicks in.
| Scenario | HDHP | PPO | Kaiser Bronze | Kaiser Gold | Non-Kaiser HMO | EPO | Excellent Plan |
|---|---|---|---|---|---|---|---|
| Worst Case | ~$450 | ~$285 | ~$360 | ~$190 | ~$400 | ~$380 | $30 |
| Typical Case | ~$330 | ~$180 | ~$225 | ~$120 | ~$270 | ~$230 | $30 |
| Best Case | ~$140 | ~$95 | ~$95 | ~$45 | ~$95 | ~$95 | $30 |
Note: What This Table Means for You
Note: This table shows your estimated out-of-pocket cost per session if you complete all 21 sessions of Spravato under the Specialty Pharmacy billing model.
The cost per session depends heavily on where you are in your insurance cycle:
- Worst case: You haven’t met your deductible, so you’re paying full price until it’s reached.
- Typical case: You’ve met part of your deductible, and are now splitting costs through coinsurance (typically 20–40%).
- Best case: You’ve already hit your out-of-pocket maximum, so insurance covers 100% and your cost drops to zero—or just a small flat copay.
If you’re early in the year or just starting treatment, expect higher costs in the beginning. If you’ve already paid toward your deductible from other care, your per-session cost could be significantly lower. This table gives you a realistic sense of what each appointment might cost you depending on your plan—and when you start.
Spravato Total Cost — Buy and Bill Insurance Model (21 Sessions)
The table below shows your estimated out-of-pocket costs for completing all 21 Spravato sessions under the Buy and Bill model—where the clinic purchases the medication directly and bills your insurance for the full session.
Each column represents a different type of commercial insurance plan. Each row reflects a different coverage scenario, depending on how much of your deductible or out-of-pocket maximum you’ve already met at the time treatment begins.
These totals include both the medication and the clinical time required to administer and monitor each session.
| Cost Scenario | HDHP | PPO | Kaiser Bronze HMO | Kaiser Gold HMO | Non-Kaiser HMO | EPO | Excellent Plan |
|---|---|---|---|---|---|---|---|
| Worst Case | $9,450 | $6,000 | $7,500–$8,200 | $3,500–$4,000 | $7,000–$9,450 | $6,000–$8,700 | $630 |
| Typical Case | $6,500–$8,000 | $3,800–$5,000 | $5,000–$6,500 | $2,000–$3,200 | $5,000–$7,000 | $4,500–$6,500 | $630 |
| Best Case | $2,500–$3,800 | $1,500–$2,800 | $1,500–$3,000 | $700–$1,200 | $1,500–$3,000 | $1,500–$3,000 | $630 |
Note: What This Table Means for You
This table shows your estimated out-of-pocket cost for the full 21-session Spravato protocol when billed under the Buy and Bill model.
Under this model, the clinic handles everything—they purchase the medication, provide monitoring, and bill your insurance for the entire session as one combined charge. That simplifies billing but doesn’t always lower your costs. In some plans, it may accelerate how quickly you hit your deductible or out-of-pocket max. In others, it could raise your cost per session if your insurance processes the claim differently than it would for pharmacy-dispensed medications.
The scenarios are defined as follows:
- Worst case: You haven’t met your deductible. You’re responsible for the full session cost until you do.
- Typical case: You’ve met part of your deductible and are now splitting the cost with insurance through coinsurance.
- Best case: You’ve already met your out-of-pocket maximum. Insurance covers 100% of eligible costs, leaving you with little to no additional expense.
If your plan uses Buy and Bill and you’re starting treatment early in the year, expect to pay thousands up front before your costs taper off. If you’re further into the year or have already had significant medical expenses, your total cost could be much lower.
Spravato Per-Session Cost — Buy and Bill Model Breakdown
This table shows your estimated out-of-pocket cost per session if you complete all 21 Spravato treatments under the Buy and Bill model. In this model, the clinic provides the drug directly and bills your insurance for the full visit—including medication and monitoring—as a single claim.
Costs vary based on your insurance plan and where you are in your coverage year. The estimates below reflect three typical scenarios and show how costs change once deductibles and out-of-pocket maximums are met.
| Scenario | HDHP | PPO | Kaiser Bronze | Kaiser Gold | Non-Kaiser HMO | EPO | Excellent Plan |
|---|---|---|---|---|---|---|---|
| Worst Case | ~$450 | ~$285 | ~$390 | ~$190 | ~$425 | ~$390 | $30 |
| Typical Case | ~$360 | ~$235 | ~$295 | ~$150 | ~$310 | ~$280 | $30 |
| Best Case | ~$180 | ~$135 | ~$180 | ~$60 | ~$180 | ~$180 | $30 |
Note: What This Table Means for You
Depending on how your plan processes Buy and Bill claims, your deductible and coinsurance structure may apply differently than under the Specialty Pharmacy model.
The scenarios are defined as follows:
- Worst case: You haven’t met your deductible, so you’re paying the full per-session cost until you do.
- Typical case: You’ve met part of your deductible and are now paying coinsurance—typically 20% to 40% of each session cost.
- Best case: You’ve already hit your out-of-pocket maximum, so insurance covers the rest and your cost drops to zero—or a small flat copay.
If you’re starting treatment early in the year or have a high-deductible plan, expect to pay more upfront. If you’ve already used other medical services, your costs may drop significantly as insurance picks up more of the bill.
What These Spravato Cost Estimates Are Based On
These numbers are based on real billing data and typical commercial insurance plan designs. Here’s what we assumed:
- Spravato protocol: 21 sessions over 6 months (FDA standard for induction + maintenance)
- Buy and Bill session cost: ~$1,800 billed per visit (drug + clinic time)
- Specialty Pharmacy session cost: ~$600–$950 (drug) + ~$300–$750 (clinic) = ~$1,000–$1,200 total billed per visit
- Coinsurance: 20% across most PPOs, HMOs, and EPOs
- Flat copays (where applicable): $30/session (used only in “Excellent Plan”)
- Out-of-pocket maximums: Range from ~$4,000 (Gold HMO) to $9,450 (HDHP), based on 2024 plan designs
- No secondary insurance or manufacturer assistance included
- No surprise billing, denials, or claim reprocessing factored in
- No financial aid programs applied
How to Estimate Your Spravato Costs Before Treatment
This page gives you the best estimates available—but you still need to confirm with your clinic and insurer. Here’s what to ask:
- Do you use Buy and Bill or the Specialty Pharmacy model?
- Will I get one bill or two?
- Is Spravato billed to my medical benefits, pharmacy benefits, or both?
- What’s the per-session charge until my deductible is met?
- What happens after I hit my out-of-pocket max?
- Can you provide a cost estimate before I start treatment?
This treatment can be life-changing. But it can also be financially overwhelming if you’re not prepared. Now you are.
How to Lower Your Spravato Costs with Manufacturer Subsidies
If you have commercial or private health insurance that covers Spravato, you may qualify for the manufacturer’s savings program—which could bring your medication cost down to just $10 per session, with up to $8,150 in savings per year.
There’s no income requirement to qualify, but you do have to meet three conditions:
- You must be 18 or older
- You must have private or employer-based insurance that covers Spravato
- You can’t be enrolled in Medicare, Medicaid, TRICARE, or any other government health program
This program only reduces the cost of the medication—it doesn’t apply to the observation period or facility fees. So you may still owe part of the clinic visit cost, depending on your deductible and coinsurance.
Still, for eligible patients, it can make a massive difference. If you’re insured and approved for Spravato, there’s no reason not to check.
What You Need to Know About Spravato Costs—At a Glance
- Even if Spravato is covered, it can still be expensive.
Insurance coverage just means they’ll pay eventually. You may still owe thousands upfront before your deductible is met. - Most people end up paying around $250 per session—on average.
But that’s just the median. Some pay less. Some pay a lot more. What you owe depends on your plan. - The first few sessions are usually the most expensive.
If your deductible hasn’t been met, you could owe $1,800 per visit in the beginning. After that, costs drop fast. - How your clinic bills the drug changes everything.
Some clinics buy the drug and bill your insurance for the full session. Others have the drug shipped in separately and bill you in two parts. You don’t get to choose—your insurer does. - Your plan type matters more than you think.
PPOs and Gold HMOs tend to have better protections. High-deductible plans hit hardest early on. Flat copay plans are rare. - What you’ll pay depends on four things:
- How high your deductible is
- How much of it you’ve already met
- Whether you pay coinsurance or a flat copay
- When you hit your out-of-pocket max
- Whether you’re eligible for manufacturer savings on the medication
Ask questions before you start.
Ask your clinic exactly what they charge, how they bill it, and what model your insurance uses. Surprises here cost real money.
How to Estimate Your Out-of-Pocket Costs for Spravato Nasal Spray (Step-by-Step)
This is a step-by-step guide to estimating what Spravato nasal spray will cost you with insurance—per session and in total.
If your insurance doesn’t cover Spravato, this guide won’t apply.
But if it’s covered—even partially—this will help you estimate what you’ll still owe out of pocket.
This guide is focused on commercial insurance (like PPOs, HMOs, and EPOs).
Medicare and Medicaid have different rules—and in many cases, don’t cover Spravato at all.
Spravato is technically covered by many insurance plans. That doesn’t mean it’s affordable. What you pay depends on your deductible, coinsurance, how your clinic bills the medication, and where you are in your plan year.
Spravato isn’t taken once or as-needed—it’s given on a strict schedule of 21 sessions over 6 months. That’s why knowing your cost up front is so important. It’s not a one-time decision—it’s a series of appointments you have to commit to.
What You’ll Need
- Your health insurance card or login to your insurer’s portal
- The name and phone number of your Spravato treatment clinic
- 10–15 minutes to call and ask the right questions
- A notepad or screenshot app—you’ll want a written record
Step 1: Look up your insurance plan’s key numbers
You’ll need to know:
- Deductible – How much you pay before insurance starts helping
- Coinsurance – The percentage you owe after meeting your deductible
- Out-of-pocket maximum – The most you’ll pay in a year
- Copay vs. coinsurance – Does your plan charge a flat fee per visit, or a percentage?
You can usually find this in your plan summary or by calling the number on your insurance card.
Step 2: Ask your clinic how they bill for Spravato
This one decision changes everything. Ask:
- “Do you use Buy and Bill, or a specialty pharmacy?”
- “What’s the total charge per session before insurance?”
- “Will I receive one bill or two (clinic and pharmacy)?”
- “Can I speak to your billing coordinator if needed?”
Why this matters:
In the Buy and Bill model, the clinic buys the drug and bills your insurance for both the medication and the visit—usually around $1,800 per session.
In the Specialty Pharmacy model, the drug (about $600–$950) is shipped to the clinic separately, and you’re also billed for the clinic time ($300–$750).
Step 3: Estimate your cost for the first few Spravato sessions
If you haven’t met your deductible, you’ll owe the full cost upfront.
Rough estimates:
- Buy and Bill: $1,400–$2,200 per session
- Specialty Pharmacy: $900–$1,200 total per session (drug + clinic)
If your deductible is $2,000, you might pay the full cost for your first session or two, until that threshold is met.
Step 4: Calculate what you’ll owe after insurance kicks in
After the deductible, your coinsurance applies. That’s the percentage you still owe.
Example:
- If your session costs $1,800 and your coinsurance is 20%, you’ll pay $360 per session
- That continues until you hit your out-of-pocket max
- After that, your cost may drop to $0–$30 per session, depending on your plan
If your plan uses flat copays, you might only owe $30–$75 per visit once your deductible is satisfied.
Step 5: Check where you are in your plan year
Spravato is usually delivered over 5–6 months.
- If you start treatment in January, your deductible is probably untouched—so you’ll pay more up front
- If you start in August and already had medical costs, you may be close to hitting your deductible or out-of-pocket max—so your cost will be much lower
Step 6: Ask for a written cost estimate
Before starting treatment, ask:
- “How many sessions are planned over the next 6 months?”
- “What’s the per-session charge?”
- “Have you run a benefits investigation with my insurance?”
- “Can I get a written estimate of what I’ll owe?”
This isn’t being difficult. It’s being prepared. Spravato costs vary widely—and surprise bills can derail treatment that’s already hard to commit to.
Step 7: Estimate your total cost for all 21 Spravato treatments
Multiply your expected per-session cost by 21.
- $300 per session × 21 = $6,300
- If early sessions cost $1,800 and later ones cost $30, use a blended average
- Or refer to our plan-based cost tables above to get a typical, worst-case, and best-case estimate based on your insurance type
Quick Estimate Tool
Use this simple method to ballpark your costs:
- Look up your deductible
- Assume $1,800 per session until the deductible is met
- Then assume $300 per session with coinsurance
- Once you hit your out-of-pocket max, assume $0–$30 per session
- Multiply each tier by the number of sessions in that phase
This isn’t perfect—but it gets you 90% of the way there.
Questions to Ask Your Clinic or Insurer
- “Do you use Buy and Bill or a specialty pharmacy?”
- “What’s the full session cost before insurance?”
- “Will I get one bill or two?”
- “Have you run a benefits investigation with my insurance?”
- “Can you give me a written cost estimate before we start?”
What to Watch Out For
If your clinic does any of the following, press pause:
- Can’t explain how they bill Spravato
- Won’t tell you what they charge per session
- Say “your insurance covers it” but haven’t checked your benefits
- Bill under hospital rates when you’re being seen in an outpatient setting
- Push you to start before confirming costs
Surprise bills are real. Good clinics help you avoid them.
Why This Matters
Getting help shouldn’t come with hidden costs.
The more you know before you start, the more energy you can put toward getting better—not just getting answers.
Takeaway
This seven-step guide walks you through estimating Spravato costs—using your deductible, billing model, session charges, and plan year to avoid surprise bills before you start treatment.