Ketamine Therapy Costs & Insurance Coverage
A Comparison Between Ketamine IV Infusions, Esketamine Nasal Spray, and Injections
Hopefully, this website has convinced you that therapy with ketamine is the most powerful tool for treating depression–far more effective than traditional antidepressants. If you’re here, you might be ready to give it a try. Unfortunately, starting ketamine therapy isn’t as simple as strolling into a café and ordering your favorite latte. The reality is more like trying to navigate a maze where each path has different rules, costs, and obstacles to consider.
That’s because ketamine can be administered in three ways—esketamine nasal spray, ketamine infusions, and injections—and each comes with its own price tag, insurance coverage, level of effectiveness, and number of required treatment sessions. Of the three, only one, Spravato, the nasal spray for depression, is (partially) covered by insurance.
Let’s start the analysis with this overview chart. Details for each category are laid out below it.
Ketamine Administration Costs & Insurance Coverage
| Spravato Esketamine Nasal Spray | Ketamine IV Infusion | Ketamine Injection | |
|---|---|---|---|
| 100% Self Pay |
Total Cost $24,598 ($1757 avg cost per treatment x 14 treatments). |
Total Cost
$6,000 ($600 avg cost per treatment x 10 treatments) |
Total Cost $3,380 ($338 avg cost per treatment x 10 treatments) |
| Commercial Insurance Coverage |
Average Cost Per Visit $612 (out-of-pocket cost)
Total Cost for 14 Sessions $8,568 (out-of-pocket cost) |
IV infusions are not covered by insurance | Injections are not covered by insurance |
|
Commercial Insurance Coverage
(with manufacturer subsidy) |
The SPRAVATO withMe Savings Program If you have commercial or private health insurance that covers Spravato, you may qualify to pay just $10 per treatment for the medication, with a maximum savings of $8,150 per year. |
IV infusions are not covered by insurance | Injections are not covered by insurance |
| MEDICARE COVERAGE |
Medicare Covers Spravato They cover your clinic visits under Part B and the medication itself under Part D. |
Medicare does not cover IV infusions. | Medicare does not cover injections |
| MEDICAID COVERAGE |
Medicaid Covers Spravato Coverage varies significantly by state. Some states fully cover it while others don't cover it at all. |
Medicaid does not cover IV infusions. | Medicaid does not cover injections. |
- The number of treatments varies depending on the method of administration. Spravato, the esketamine spray, typically involves 14 sessions following the treatment regimen recommended by the manufacturer and informed by FDA-approved guidelines. In contrast, Ketamine IV therapy and injection protocols are customized to the patient’s needs. Generally, ketamine infusion and injection therapy require fewer sessions than Spravato to achieve significant relief or remission.
- Further details about this chart and helpful links are provided below.
- See my table comparing ketamine costs/coverage to SSRIs.
IV INFUSIONS
Insurance Won’t Cover the Cost of Ketamine Treatment for IV Infusions
Commercial insurance, Medicare, and Medicaid won’t cover ketamine IV infusions (or injections) because they’re considered “off-label.”
But wait! The Mayo Clinic reports that 21% of prescriptions for the most popular medications are for off-label uses, and insurance regularly covers them without issue. Yet, when it comes to ketamine—a treatment with life-changing potential for depression—they suddenly draw the line. It’s a glaring double standard that leaves countless people without access to a proven option for relief.
Next, they claim that ketamine IV therapy lacks standardization—pointing to variations in dosage, number of treatments, and frequency of treatments as their justification. But this argument falls apart when you consider that insurance routinely covers treatments like chemotherapy and psychiatric medications, both of which often require constant adjustments to dosing and schedules. The double standard is hard to ignore, especially when IV ketamine has shown such promising results for depression.
Finally, they argue there’s not enough clinical evidence, disregarding over 20 years of research and real-world success that far outpaces Spravato, the FDA-approved alternative. The result? Insurers cover a more expensive, potentially less effective option while shutting out a proven, more affordable treatment—forcing patients to pay the price for policies that prioritize bureaucracy over better care. Click here for my rant on why insurance won’t cover IV infusions and injections, but should.
Bottom line: Your only option for the gold standard in ketamine therapy is to pay 100% out-of-pocket. Still, you can save lots of money by checking out How to Lower the Cost of Ketamine Treatments Not Covered by Insurance.
Here are your out-of-pocket costs:
Cost of Ketamine
Included in per visit charge.
Cost of Clinic Visit
Included in per visit charge.
Average Cost Per Visit
$400 – $800 per treatment. Assume midpoint of $600.
3-month protocol (6-14 treatments). Assume midpoint of 10
No fixed # of treatments like Spravato (requires at least 14). Depends on patient response.
Total Cost of Ketamine Treatment
$6,000
($600 avg cost per treatment x 10 treatments).
Research shows ketamine IV infusions are more effective
Over 25 years of research proves IV infusions are more effective, longer-lasting, and require fewer treatments than Spravato. The real issue is that ketamine is a low-cost, generic drug, leaving no financial incentive for pharmaceutical companies to fund the expensive FDA approval process.
Meanwhile, Spravato—essentially a patented version of ketamine (esketamine)—had the resources of a large pharmaceutical company to secure FDA approval. Insurers ignore IV ketamine not because it doesn’t work, but because it lacks the FDA stamp, a technicality that has nothing to do with its effectiveness. This chaps my ass more than a three-foot flame because this isn’t about patient care—it’s about profits.
Find out why the FDA approved a nasal spray but not IV infusions and injections.
INJECTIONS
Injections Aren’t Covered By Insurance
(Commercial, Medicare Or Medicaid)
Cost of Ketamine in the Injection
Included in per visit charge.
Cost of Ketamine Clinic Visit
Included in per visit charge.
Average Cost Per Visit
$275 – $400 per treatment. Assume midpoint of $338
3-month protocol (6-14 treatments). Assume midpoint of 10
No fixed # of treatments like Spravato. Depends on patient response.
Total Cost of Ketamine Therapy
$3,380
($338 avg cost per treatment x 10 treatments).
SPRAVATO NASAL SPRAY
Out-of-Pocket Costs Without Insurance Coverage
Spravato Nasal Spray Cost (esketamine)
$1,025 to $1,589 per treatment. Assume midpoint of $1,307
Cost of Ketamine Clinic Visit
$300 to $600 per treatment. Assume midpoint of $450
Average Cost Per Visit
$1,757
3-month protocol (14 treatments)
Spravato requires fixed number of treatments despite patient response
Total Cost
$24,598
($1757 avg cost per treatment x 14 treatments).
SPRAVATO NASAL SPRAY
With Insurance Coverage
Key assumptions for Spravato:
– A full treatment course of 3 months involves 14 sessions
– Medication costs $738 per dose (insurance pays 50%)
– Ketamine clinic visit costs $400 per session (insurance pays 80% after deductible)
– Average commercial insurance deductible is $1,760
– Specialist visit copays are $57.50 per session after deductible
– Medication costs use percentage-based coinsurance
I’ve created four scenarios of Spravato nasal spray costs using different criteria, such as whether you meet your deductible before starting treatment. Based on these scenarios, your out-of-pocket costs for the required number of treatments (14) could range from $7,691 to $9,451. Click here for details of each scenario.
Average Cost Per Visit
$612
(Your out-of-pocket cost)
Your Total Out-Of-Pocket Cost for 14 Sessions
$8,571
(Midpoint of four insurance scenarios involving 14 sessions).
SPRAVATO NASAL SPRAY
With Commercial Insurance AND Manufacturer Subsidy
If you have commercial or private health insurance that covers Spravato, you may qualify to pay just $10 per treatment for the medication, with a maximum savings of $8,150 per year.
Eligibility requirements:
- You must be 18 years or older.
- You must have commercial or private health insurance that covers Spravato.
- There is no income requirement to qualify.
Important details:
- This program only reduces the cost of the medication; not the cost of treatment observation (clinic visit)
- It is not available for patients with government-funded healthcare, such as Medicare, Medicaid, or TRICARE.
Click here to see if you qualify for Spravato’s subsidies. Learn more about why Spravato offers such a big subsidy.
SPRAVATO NASAL SPRAY
Medicare Covers Spravato
Key Points:
Coverage Eligibility:
- Medicare Part B covers the esketamine nasal spray cost as it is a physician-administered treatment requiring medical supervision.
What’s Covered:
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-
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- Esketamine cost (Spravato).
- Two-hour observation period.
- Related medical services provided in the facility.
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Costs to You:
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- Annual Part B deductible ($257 in 2025).
- 20% coinsurance after deductible, reducible with supplemental plans (e.g., Medigap, Medicare Advantage).
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Why It’s Not Under Part D (Drugs)
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- Part D covers drugs you take on your own, but since Spravato must be administered and monitored by healthcare professionals, it falls under Part B instead. While this may seem unusual, the distinction is based on how the treatment is delivered.
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SPRAVATO NASAL SPRAY
Medicaid Covers Spravato
(Depending On The State)
Key Points:
- Medicaid generally covers Spravato, but coverage varies significantly by state – some states fully cover it while others don’t cover it at all.
- When covered, out-of-pocket costs are typically very low (usually $0-10 per visit for copays).
- Medicaid coverage rules can be different for “dual-eligible” patients (those who have both Medicare and Medicaid).
- Medicaid typically covers both the medication and facility fees, and may even cover transportation to appointments.
- Unlike with commercial insurance, Medicaid patients cannot use Johnson & Johnson’s savings program for additional cost reduction, but there may be other assistance programs available through organizations like the Johnson & Johnson Patient Assistance Foundation.
More on Ketamine Therapy Costs & Insurance Coverage