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How Much Does Spravato Cost With & Without Insurance? 2025 Cost Guide + Calculator

Michael Alvear

By Michael Alvear, Health Author & Independent Researcher

My research is published on these scholarly platforms:

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Spravato Costs At a Glance

1
Without insurance
About $1,050 per treatment. About $22,050 total for 21 sessions (first 6 months).

2
With commercial insurance (no manufacturer subsidy)

Per treatment: roughly $120–$286. Total for 21 sessions: about $2,520–$6,000.


Lower end = If your insurer pays the visit as a regular office/outpatient visit.
Higher end = If it pays it as a facility/observation visit.

3
With commercial insurance + manufacturer subsidy

Per treatment: about $50–$135. Total for 21 sessions: about $1,050–$2,835.


Lower end = If your insurer pays the visit as a regular office/outpatient visit.
Higher end = If it pays it as a facility/observation visit.

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What Spravato Costs: How Insurance Billing Changes Your Price

1
Spravato (No Insurance)
You pay the full cash price for the drug and monitoring).
Cost Per Treatment
$1,050/session
# of Treatments
21
Total Cost (Median)
$22,050
Notes: Typical cash price clinics charge per Spravato treatment (drug + 2-hour monitoring). 21 sessions is the standard FDA protocol for the first 6 months.

2
Insurance covers Spravato as a medical benefit (Buy-and-Bill)
(Commercial insurance; not Medicare or Medicaid)
The Billing Model Your Insurance Uses: “Buy and Bill” (the clinic buys Spravato and bills your insurance for both the drug and a large facility/observation fee of about $500+ per visit).
Cost Per Treatment
$286/session
# of Treatments
21
Total Cost (Median)
$6,000
Notes: The clinic supplies the drug and bills everything through your medical benefit. With a big facility/observation fee, your out-of-pocket often ends up similar to the pharmacy-benefit + facility-fee path below under the same “typical plan” assumptions.

3
Insurance covers Spravato as a pharmacy benefit + facility-fee visit
The Billing Model Your Insurance Uses: “Pharmacy Benefit” (the drug runs through your pharmacy plan, but the clinic still bills a large facility/observation fee of about $500+ per visit under your medical benefit).
Cost Per Treatment
$286/session
# of Treatments
21
Total Cost (Median)
$6,000
Notes: Because the facility/observation fee is the main cost driver, your out-of-pocket cost here usually ends up in the same ballpark as Buy-and-Bill above. Same median shown intentionally.

4
Insurance covers Spravato as a pharmacy benefit + office-visit billing
The Billing Model Your Insurance Uses: “Pharmacy Benefit” (the drug runs through your pharmacy plan, and the insurer pays this as a regular office/outpatient visit, not a facility-fee encounter.)
Cost Per Treatment
$120/session
# of Treatments
21
Total Cost (Median)
$2,520
Notes: Office/outpatient coding is cheaper and more predictable than a hospital-style facility fee, so patient costs drop even though the drug is still under the pharmacy benefit.

5
Insurance + Manufacturer Subsidy, drug as a medical benefit (Buy-and-Bill)
The Billing Model Your Insurance Uses: “Buy and Bill” (the clinic buys Spravato, bills your insurance for the drug and facility/observation fee, and you also receive manufacturer copay assistance on the drug portion).
Cost Per Treatment
$135/session
# of Treatments
21
Total Cost (Median)
$2,835
Notes: Manufacturer savings reduce your share of the drug cost, but you still pay part of the facility/observation fee. With facility-fee billing, costs often look similar to the pharmacy-benefit + facility-fee path below.

6
Insurance + Manufacturer Subsidy, drug as a pharmacy benefit + facility-fee visit
The Billing Model Your Insurance Uses: “Pharmacy Benefit” (the drug runs through your pharmacy plan with copay help; the clinic still bills a large facility/observation fee of about $500+ per visit under your medical benefit).
Cost Per Treatment
$135/session
# of Treatments
21
Total Cost (Median)
$2,835
Notes: Because the facility fee stays the same and the subsidy lowers your drug copay either way, your out-of-pocket cost here usually ends up very close to Buy-and-Bill + subsidy above. Same median shown intentionally.

7
BEST CASE
Insurance + Manufacturer Subsidy, drug as a pharmacy benefit + office-visit billing
The Billing Model Your Insurance Uses: “Pharmacy Benefit” (the drug has manufacturer copay help, and the insurer pays this as a regular office/outpatient visit, not a facility-fee encounter.)
Cost Per Treatment
$50/session
# of Treatments
21
Total Cost (Median)
$1,050
Notes: “Best-case” example: both things break your way — copay help lowers the drug cost and office-visit coding avoids the facility fee. Many clinics and plans do not bill Spravato this way, so treat this as a lower-bound scenario.
VIEW THESE COSTS IN ONE COMPARISON TABLE
▼

This table shows typical 6-month Spravato out-of-pocket costs under different insurance billing pathways. The numbers are medians based on a “typical” commercial plan example, so your exact price can be higher or lower.

Two rows share the same cost on purpose: when a large facility/observation fee is billed, your out-of-pocket is often similar whether Spravato is covered under the medical benefit (buy-and-bill) or the pharmacy benefit. The big swing comes from whether the visit is paid as a facility-fee encounter or a regular office/outpatient visit.

If you’re unsure which pathway your plan uses, ask your clinic: “Is Spravato billed through my medical benefit or pharmacy benefit, and is the 2-hour monitoring paid as a facility fee or an office/outpatient visit?”

What Spravato Costs: How Insurance Billing Changes Your Price

Treatment Option The Billing Model Your Insurance Uses Cost Per Treatment (Median) # of Treatments Total Cost (Median) Notes
Spravato (No Insurance) No insurance involved (you pay the full cash price for the drug and monitoring). $1,050/session 21 $22,050 Typical cash price clinics charge per Spravato treatment (drug + 2-hour monitoring). 21 sessions is the standard FDA protocol for the first 6 months.
Insurance covers Spravato as a medical benefit (Buy-and-Bill)
(Commercial insurance; not Medicare or Medicaid)		 “Buy and Bill” (the clinic buys Spravato and bills your medical insurance for the drug plus a large facility/observation fee of about $500+ per visit). $286/session 21 $6,000 Clinic bills everything through your medical benefit. With a big facility/observation fee, your out-of-pocket often ends up similar to the pharmacy-benefit + facility-fee path below. Numbers assume a sample “typical” commercial plan: $2,000 deductible, $6,000 out-of-pocket max, 20% coinsurance.
Insurance covers Spravato as a pharmacy benefit + facility-fee visit “Pharmacy Benefit” (Spravato comes from a specialty pharmacy, but the clinic still bills a large facility/observation fee of about $500+ per visit under your medical benefit). $286/session 21 $6,000 Because the facility/observation fee is the main cost driver, your out-of-pocket is usually in the same ballpark as Buy-and-Bill above. This row uses the same median under the same “typical plan” assumptions on purpose.
Insurance covers Spravato as a pharmacy benefit + office-visit billing “Pharmacy Benefit” (Spravato runs through your pharmacy plan, and the insurer pays this as a regular office/outpatient visit, not a facility-fee encounter.) $120/session 21 $2,520 Key difference is how the visit is coded. Office-visit billing is cheaper and more predictable than a hospital-style facility fee, so patient costs drop even when the drug is still under the pharmacy benefit.
Insurance + Manufacturer Subsidy, drug as medical benefit (Buy-and-Bill) “Buy and Bill” (the clinic buys Spravato and bills your insurance for the drug and facility fee, while manufacturer copay help lowers your drug share). $135/session 21 $2,835 Manufacturer savings reduce your share of the drug, but you still pay part of the facility/observation fee. With facility-fee billing, costs often look similar to the pharmacy-benefit + facility-fee path below under the same “typical plan” assumptions.
Insurance + Manufacturer Subsidy, drug as pharmacy benefit + facility-fee visit “Pharmacy Benefit” (the drug runs through your pharmacy plan with copay help, but the clinic still bills a large facility/observation fee under your medical benefit). $135/session 21 $2,835 Because the facility fee stays the same and the subsidy lowers your drug copay either way, your out-of-pocket is usually very close to Buy-and-Bill + subsidy above. Same median shown intentionally.
Insurance + Manufacturer Subsidy, drug as pharmacy benefit + office-visit billing (Best case) “Pharmacy Benefit” (the drug has manufacturer copay help, and the insurer pays this as a regular office/outpatient visit, not a facility-fee encounter.) $50/session 21 $1,050 “Best-case” example: both things break your way — copay help lowers the drug cost and office-visit coding avoids the facility fee. Many clinics and plans do not bill Spravato this way, so treat this as a lower-bound scenario.

Why The Total 21-Session Cost for Spravato Ranges from $1,050 to $22,050

This table shows how the same 21 Spravato sessions can cost about $22,050 in one scenario and as little as about $1,050 in another. That’s a swing from roughly $1,050 per treatment with no insurance down to $50 per treatment when everything breaks in your favor. Here’s why the spread is so big.

1. Insurance vs. no insurance: baseline Spravato cost

The first fork in the road is simple: do you have insurance or not?

  • No insurance → around $1,050 per treatment, $22,050 total for 21 sessions.
  • Any decent commercial plan → you usually drop into the hundreds per treatment and thousands total, not tens of thousands.

2. How “good” your health insurance plan is

All the insurance rows in the table use one sample, “typical” commercial plan so you can compare apples to apples:

  • $2,000 deductible
  • $6,000 out-of-pocket maximum
  • 20% coinsurance

In real life, people sit all over the map: $500 deductibles, $3,000 deductibles, $7,000+ deductibles, different coinsurance, different out-of-pocket max. If your deductible and out-of-pocket max are higher than the sample plan, your costs can easily land thousands of dollars above the medians shown here.

3. Where you are in your deductible and out-of-pocket max when you start Spravato

Even with the same plan, timing changes everything.

  • If you have a $3,000 deductible and you start Spravato in January with $0 spent, you may eat most or all of that $3,000 while doing induction.
  • If you start after you’ve already met your deductible (because of surgery, scans, etc.), you might skip that entire $3,000 hit.

Guide Author

What Does Spravato Cost With Insurance?

14 essential sections to estimate, compare, and lower your out-of-pocket costs

1
MOST POPULAR
Spravato Insurance Cost Calculator
Plug in your deductible, coinsurance, and plan timing to see your real session-by-session costs.

1 min read ›

2
The Median Out-of-Pocket Cost for Each Session of Spravato
Why “$250 per session” is true, and also wildly misleading if you don’t know how costs front-load.

3 min read ›

3
The Total Out-of-Pocket Cost for a Full Course of Spravato
What most people pay for 21 FDA-standard sessions, and why totals swing so hard.

1 min read ›

4
FAQs
Fast, blunt answers on deductibles, Medicare/Medicaid, savings programs, and surprise bills.

7 min read ››

5
A Session-by-Session Look at What You’ll Actually Pay with Insurance
A realistic cost curve from $1,800 early visits to near-zero late ones.

3 min read ›

6
Total Out-of-Pocket Costs by Plan and Billing Model
How “Specialty Pharmacy” vs “Buy and Bill” quietly rewrites your bill.

3 min read ›

7
Total Out-of-Pocket Cost (21 Sessions) — “Specialty Pharmacy” Model
Full-course totals across HDHP, PPO, HMO, EPO, and rare “excellent” plans.

2 min read ›

8
Estimated Per-Session Cost (21 Sessions) — “Specialty Pharmacy” Model
What each visit looks like once deductibles and coinsurance do their thing.

1 min read ›

9
Total Out-of-Pocket Cost (21 Sessions) — “Buy and Bill” Model
Same 21 sessions, different billing lane, different totals.

2 min read ›

10
Estimated Per-Session Cost (21 Sessions) — “Buy and Bill” Model
Per-visit ranges when the clinic bundles everything into one claim.

1 min read ›

11
Key Assumptions Used in These Estimates
Exactly what numbers the calculator and tables assume—and what they don’t.

1 min read ›

12
How to Lower Your Spravato Costs with Manufacturer Subsidies
Who qualifies, what it covers, and why it can drop your costs by thousands.

2 min read ›

13
What You Need to Know About Spravato Costs—At a Glance
The whole cost logic in one quick, skimmable list.

2 min read ›

14
How to Estimate Your Out-of-Pocket Costs (Step-by-Step)
A practical 7-step method to forecast your real total before you start.

9 min read ›

 

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The Problem With Most Spravato Price Estimates—And How This Calculator Fixes It

Most websites just give you a single price per session for Spravato—like “$400″—without explaining how many sessions you’ll need or how your insurance actually changes what you pay over time. This calculator is different.

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Here’s the problem with most online cost information for Spravato: they give you one number per session (like “$400”) without telling you how many sessions you’ll actually need. It’s like a car dealer telling you the monthly payment but not mentioning it’s a 7-year loan.

The truth is, most websites don’t even have cost calculators for Spravato nasal spray—they just list a single session price and leave you guessing about your total treatment cost. Even the few calculators that do exist ask for basic information like your deductible and coinsurance rate, then spit out one generic estimate for “per session.”

That approach is completely useless because:

  • They don’t tell you Spravato requires 21 sessions over 6 months (we’ll explain this FDA-approved schedule in the next section)
  • Your cost per session changes dramatically as treatment progresses—your first session might cost $1,325 while your 18th session could be completely free
  • They ignore how insurance actually works—once you meet your deductible or hit your out-of-pocket maximum, your costs drop significantly
  • They don’t account for when you start treatment—beginning in January vs November can change your total costs by thousands of dollars

It’s like trying to budget for a cross-country road trip when someone only tells you the price of gas per gallon, but not how many gallons you’ll need or that gas prices change from state to state.

This calculator assumes Spravato is covered under your medical benefit

That’s common but not universal. If your insurance covers Spravato as a pharmacy benefit, your actual out-of-pocket costs may differ—sometimes by more than 10%-20%—depending on your plan’s pharmacy deductible, coinsurance, and out-of-pocket maximum. For most users, the estimate should be in the right ballpark, but for some, especially if your pharmacy benefit has a much higher coinsurance or a separate deductible, your actual costs could be higher. Why didn’t I build a pharmacy benefit calculator? Because it would be practically useless. Keep reading and you’ll see why.

Most insurance plans have a combined out-of-pocket maximum that caps your total annual spending on covered medical and pharmacy services. If you reach this maximum, your total costs for the year will be similar regardless of whether Spravato is billed under your medical or pharmacy benefit. However, some plans have separate out-of-pocket maximums for medical and pharmacy benefits, which could affect your total costs. For the most accurate estimate, check your benefit details or contact your insurer or provider.

NOTE: Most clinics charge a separate $525 facility fee for each Spravato session. We include that in our estimates because it’s part of what patients actually pay. But here’s something most people don’t realize: some insurance plans treat this fee as a behavioral health service, not a medical one. That small detail can make a big difference—behavioral health benefits often mean lower copays and no deductible.

So while we use $525 as a standard estimate, your actual cost may be less depending on how your insurer classifies it.

How This Calculator Shows Your Real Session-by-Session Spravato Costs

This tool is completely different because it starts with the FDA-approved Spravato protocol that your doctor will actually follow: 21 sessions over 6 months in a very specific schedule (8 sessions in month 1, 4 sessions in month 2, then 2–3 sessions per month for months 3–6—we’ll break this down in detail in the next section).

Then it calculates the actual cost for each individual session based on where you are in your insurance year and treatment protocol. You’ll see exactly:

  • What you’ll pay for sessions 1–8 during the intensive first month
  • How your costs change in month 2 when you switch to weekly sessions
  • The exact session where you’ll meet your deductible (and watch your costs drop)
  • Whether later sessions become free after reaching your out-of-pocket maximum
  • How the Spravato withMe savings program affects each session differently

For example, if you start treatment in March with a $3,000 deductible, you might pay $1,325 for your first few sessions, then $265 per session after meeting your deductible around session 6, then $0 per session after hitting your out-of-pocket max around session 15.

Think of it like a GPS for your treatment costs—instead of just telling you the destination, it shows you every turn along the way and when you’ll hit traffic (high costs) versus when the road opens up (lower or free sessions).

Why Starting Month Matters More Than You Think for Spravato Costs

Here’s something no other calculator tells you: when you start Spravato treatment can easily affect your total costs by $2,000 or more.

Starting in January gives you the full year to hit your out-of-pocket maximum, potentially making your final 6–9 sessions completely free. Start in November, and you’ll hit your deductible twice—once in November/December, then again in January when everything resets.

This calculator models exactly what happens when your treatment crosses over into a new calendar year, including how it affects your withMe program benefits (which also reset annually).

How Family Insurance Plans Make Spravato Costs More Complicated

Most calculators assume you have an individual plan. But if you’re on a family plan, you actually have two sets of deductibles and out-of-pocket maximums to consider: your individual limits and the family limits.

This calculator handles the complex math of embedded individual deductibles within family plans. It knows that you might meet your individual $2,500 deductible after 6 sessions, but your family still needs to hit the $5,000 family deductible before everyone gets coinsurance rates.

This stuff gets complicated fast, and most online tools simply can’t handle it.

See Exactly When Your withMe Savings Will Run Out

The Spravato withMe savings program can reduce your medication cost from $800 per session down to just $10. Sounds great, right? But here’s what other calculators don’t tell you: the program has an $8,150 annual cap, and it only applies to medication costs, not facility fees.

This calculator shows you exactly when your withMe benefits will run out based on your specific coinsurance rate. If you have 20% coinsurance, your withMe benefits might last all 21 sessions. If you have 10% coinsurance, the program could be exhausted by session 12, and you’ll pay regular insurance rates for the remaining sessions.

It also reminds you that withMe requires annual re-enrollment—something many people forget and lose coverage over.

Real Insurance Data vs Made-Up Estimates

Every number in this calculator comes from real reimbursement data, not theoretical pricing or inflated “chargemaster” rates that patients never actually pay.

We use actual contracted rates from commercial insurers, billing data from certified REMS clinics, and transaction records from provider platforms. The $800 medication cost and $525 facility fee aren’t random numbers—they reflect what insurance companies actually reimburse providers for Spravato treatment.

Other calculators often use list prices or outdated estimates that can be off by hundreds of dollars per session.

No Other Tool Models Insurance Logic This Accurately

Even Janssen’s official website doesn’t provide this level of personalized, session-specific detail. No other calculator models the actual complexity of how insurance really works with Spravato treatment.

This tool understands that insurance doesn’t work in simple percentages. It knows how to split the $1,325 per session between medication and facility costs, apply them correctly to your deductible, factor in coinsurance rates, and stop charging you once you hit your out-of-pocket maximum.

That’s the difference between a generic estimate and a tool that actually helps you plan for the real financial journey of Spravato treatment.

How the Month You Start Spravato Affects Your Total Cost

If you haven’t met your deductible yet and have flexibility in when to start Spravato, beginning early in the year can sometimes offer the lowest total cost. But that’s not always true. The real cost difference comes down to where you are in your insurance cycle—not just what month it is.

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Example 1: Starting in January (Deductible Not Yet Met)

Sarah has a $3,000 deductible and a $7,000 out-of-pocket maximum. She hasn’t had any major medical expenses yet. If she starts Spravato in January, she’ll hit both thresholds over the course of treatment and eventually pay nothing by the end.

  • Sessions 1–4: $1,325 each = $5,300 (used to meet deductible and chip away at OOP max)
  • Sessions 5–12: $265 each (20% coinsurance) = $2,120
  • Sessions 13–21: $0 each = $0 (hit out-of-pocket max)

Total January start cost: $7,420

Example 2: Starting in April After Meeting Deductible

Now imagine Sarah has the same $3,000 deductible and $7,000 out-of-pocket max—but she already met her deductible earlier in the year from unrelated medical care. If she starts Spravato in April, her costs drop right away.

  • Sessions 1–8: $265 each = $2,120 (coinsurance only)
  • Sessions 9–15: $265 each = $1,855
  • Sessions 16–21: $0 each = $0 (hit OOP max by session 16)

Total April start cost: $3,975

What’s the Difference?

Starting in April—after hitting your deductible—saves Sarah $3,445 compared to a January start. That’s a 46% drop in total cost, just from timing her treatment to match her insurance progress.

Bottom Line

If you haven’t met your deductible yet, starting earlier in the year gives you the full calendar year to reach your out-of-pocket maximum—and that can minimize long-term costs. But if you’ve already hit your deductible (or are close), starting mid-year can be dramatically cheaper. The calculator models both scenarios to show exactly how timing and insurance status affect your cost curve.

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Spravato nasal spray insurance estimator

How the Spravato withMe Savings Program Dramatically Changes Your Medication Costs

The withMe program can dramatically reduce your out-of-pocket costs—but only if you understand exactly how it works, where its limits are, and when to renew. This calculator models your savings session by session.

See full breakdown

What the withMe Program Covers

The withMe savings card reduces your medication cost from $800 to just $10 per session. That’s potentially $790 in savings per treatment—or up to $16,590 across the full 21-session Spravato protocol.

What It Doesn’t Cover

The $525 facility fee still applies to your deductible and coinsurance just like any other medical service. Think of withMe like a coupon for the medication—but it doesn’t change what you pay the clinic for medical supervision, staffing, or recovery room time.

The Annual Cap: Where Savings Can Run Out

WithMe provides a maximum of $8,150 in medication savings per calendar year. Depending on your coinsurance rate and when you start treatment, this might cover the entire cost of the medication—or it could run out partway through.

Once the cap is reached, your insurance kicks back in and you pay your normal share of the medication cost (usually 10–30%). The calculator estimates when this transition happens based on your specific plan inputs.

Example: 20% Coinsurance With and Without withMe

  • Without withMe: $160 (20% of $800) medication + $105 (20% of $525) facility = $265 per session
  • With withMe: $10 medication + $105 facility = $115 per session
  • Annual withMe savings: Up to $8,150, which could cover medication costs for all 21 sessions in this case

WithMe Program Annual Renewal: Don’t Lose Your $10 Medication Rate

Here’s something that catches many patients off-guard: the withMe savings program requires annual re-enrollment, and if you miss the deadline, you lose your $10 medication rate immediately.

It’s like a gym membership that doesn’t auto-renew—if you forget to re-sign up before January 1st, you’re suddenly paying full price until your new application is approved.

Critical withMe Timing Facts

  • Re-enrollment period: Typically opens in November for the following year
  • Application deadline: Must be completed before January 1st
  • Coverage gap risk: Miss the deadline, and you pay $800 per session until approved
  • No retroactive coverage: You can’t get withMe savings backdated for past sessions

Planning Tip for Cross-Year Treatment

If your treatment spans into the new year, set a calendar reminder for October to start your withMe renewal process. Don’t wait until December—applications can take several weeks to process.

For example, if you’re in session 15 in December and forget to renew withMe, your January sessions could jump from $115 each (with withMe) to $625 each (without withMe) until your renewal is approved.

The bottom line: withMe turns your biggest cost—medication—into your smallest. But you still need to budget for facility fees, track your annual cap, and remember to re-enroll each year. This calculator accounts for all of it.

Where Our Numbers Come From—and Why They’re Closer to What You’ll Really Pay

The $800 medication cost and $525 facility fee in this calculator aren’t made-up estimates—they’re built from real negotiated rates between commercial insurers and actual Spravato providers. Here’s how we got them.

See full breakdown

Real-World Data Sources We Used

Our research drew from multiple clinical and reimbursement data sets to establish realistic, insurer-paid pricing—not list prices or theoretical estimates. These included:

  • Bespoke Treatment: Clinic reports show insurers reimbursing $1,400–$2,000 per session
  • Axis Integrated Health: Reports drug-only costs of ~$700 (56mg) to ~$1,200 (84mg) per dose
  • Osmind Provider Platform: Data shows clinics paying $700–$900 for 84mg doses
  • FAIR Health & Turquoise Health: Transparency tools show medication ranges of $600–$1,000 and facility fees of $300–$700+

For context: hospitals may list Spravato treatment at “$2,500 per session” on a chargemaster, but the actual insurer-negotiated rate is typically around $1,325–$1,450—consistent with what this calculator uses.

How We Determined the $800 Medication and $525 Facility Fee Split

The $1,325 per-session figure is based on billing norms and average reimbursement behavior from both providers and insurers. We split it as follows:

  • $800 medication cost (HCPCS S0013): Reflects insurer reimbursement for Spravato nasal spray, based on:
    • Provider acquisition costs ($700–$900 for 84mg)
    • Typical reimbursement margins observed across commercial plans
    • Clinic reports showing drug reimbursement in the $700–$1,000 range
  • $525 facility fee (CPT 99214 + 99417): Covers clinical monitoring, medical supervision, and 2–3 hour observation period. Based on:
    • Psychiatric billing codes + prolonged service add-ons
    • Hospital outpatient visit codes (G0463)
    • Typical regional reimbursement ranges of $300–$750

Cross-Checking With Medicare

Even though this calculator focuses on commercial plans, we use Medicare as a baseline to make sure our data is grounded. Medicare reimburses roughly $1,450 for a bundled Spravato session (84mg + monitoring), and commercial insurers typically pay 90–130% of that amount. That puts our $1,325 benchmark well within the expected range.

We treat this cross-checking process like a second opinion: it helps ensure our estimates are fair, defensible, and not driven by outliers or exceptions.

Our Commitment to Transparency

Every number in this calculator is rooted in negotiated insurance data—not hospital chargemaster fiction, not sticker-shock list prices, and not outdated pharmaceutical benchmarks.

When we tell you a Spravato session costs $1,325, it’s because that reflects what commercial insurance companies actually pay providers in the real world—validated across multiple clinics, data platforms, and billing frameworks.

Why We Didn’t Build a Separate Pharmacy Benefit Calculator for Spravato

(About 60% of commercial insurance plans treat Spravato as a pharmacy benefit. Our calculator is based on the 40% of plans that treat it as a medical benefit.)

We didn’t build a separate Pharmacy Benefit Calculator because it would require the user to call their insurance company and ask a series of questions they might not understand—and that most insurers don’t make easy to answer.

To use a pharmacy benefit calculator, you’d have to know whether Spravato is billed under your pharmacy or medical benefit (most people don’t), whether your pharmacy deductible is separate (many are), whether any of it’s been met (rarely shown), what your coinsurance rate is for Tier 5 drugs (never shown), and what your pharmacy out-of-pocket max is (often buried or missing). That’s five separate data points—most of which require calling your insurer, navigating a phone tree, and asking precise jargon-heavy questions just to get a rough estimate.

Imagine telling a depressed patient they can use a cost calculator—but first they need to call their insurance company and ask about “separate accumulators” and “specialty-tier cost shares.” It’s a nonstarter.

The medical benefit calculator we built uses data patients already know—their deductible and out-of-pocket max—and models costs based on real reimbursement rates. For most users, even if they’re under a pharmacy benefit, the results are directionally accurate and within 10–20%. We explain the assumptions and offer a clear disclaimer.

That’s why we didn’t build a second calculator: it would help fewer people, frustrate more, and undermine the whole point—making this complicated treatment easier to understand.

Important Disclaimers

This calculator is designed to help you plan for Spravato costs, but like any estimate tool, it has limitations. Here’s what you need to know before relying on the numbers.

See full breakdown

These Are Estimates, Not Guarantees

This calculator uses real negotiated insurance rates to produce cost estimates—but it can’t account for every individual plan detail. Think of it like a GPS estimated arrival time: it’s usually accurate, but your actual trip may vary depending on traffic (insurance variations).

Your actual out-of-pocket costs could be higher or lower depending on factors like:

  • Your specific plan’s deductible, copay, and coinsurance structure
  • Billing differences between providers and clinics
  • Prior authorization requirements or claim denials
  • Changes to your treatment schedule or dosage

WithMe Program Fine Print

The Spravato withMe savings program has eligibility requirements that may affect your actual savings. We use current program rules in our model, but you must verify your own eligibility directly with the program.

Key program limitations include:

  • Income restrictions may apply
  • Only available with commercial insurance plans
  • Annual re-enrollment is required
  • Program rules may change without notice

Talk to the Real Experts

This calculator is a helpful planning tool—but it’s not a replacement for your provider or insurer. Always confirm your expected costs with your treatment clinic and insurance company. They have access to your actual benefits, provider agreements, and claims history.

Use this tool to start more informed conversations—but never use it as a substitute for professional medical or financial advice.

Your Privacy and Our Data

We don’t store or transmit any of your personal information. All calculations happen locally in your browser. Your insurance inputs and results are not saved, logged, or shared.

The cost data in this calculator comes from aggregated industry sources—not individual patient records—and is used solely to help you estimate real-world treatment expenses.

Need The Full Picture?

See our complete guide to ketamine costs & insurance for totals, payer rules, and ways to reduce out-of-pocket.

2

The Median Out-of-Pocket Cost for Each Session of Spravato

Even with insurance, your out-of-pocket cost for Spravato averages $250 per session, but early visits can exceed $1,800 if your deductible isn’t met—making timing, plan type, and coverage year the biggest drivers of affordability.

It’s about $250 per session, spread across the full 21-session protocol approved by the FDA.

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.

3

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—up $1,800 for the first visit in larger metro areas—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.

4

Frequently Asked Questions About Spravato Costs

Q1

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.

Q2

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.

Q3

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

Q4

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.

Q5

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.

Q6

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. G2083 is assigned to APC 1516 under Medicare’s Outpatient Prospective Payment System (OPPS), which determines the allowed payment rate based on cost reports submitted by hospitals.

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.

★

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5

A Session-by-Session Look at What You’ll Actually Pay with Insurance

Most people with standard insurance pay about $6,000 total for the 21-session Spravato protocol—starting at $1,800 per session, dropping to $30, and averaging around $250 per session overall.

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.

6

What Does Spravato Cost with Insurance? Total Out-of-Pocket Costs by Plan and Billing Model

Your Spravato costs depend not just on the type of insurance you have, but on whether your insurer uses a specialty pharmacy to bill the drug separately or bundles it into one clinic session.

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 like Blue Cross): 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.

7

Estimated Per-Session Cost (21 Sessions) — “Specialty Pharmacy” Model

This section breaks down what each Spravato session might cost under the Specialty Pharmacy model, with per-visit estimates ranging from $450 to $30 based on your plan and insurance status.

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

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.

8

Per-Session Spravato Cost — Specialty Pharmacy Billing Model

This section breaks down what each Spravato session might cost under the Specialty Pharmacy model, with per-visit estimates ranging from $450 to $30 based on your plan and insurance status.

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

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. In these cases, providers often bill CPT code 99214 for the in-person monitoring visit.

This represents a moderate-complexity outpatient evaluation and management service, typically used when the Spravato session is conducted in a clinic setting and lasts 45 minutes or more. If the session extends to two hours (as required by the REMS protocol), additional time is frequently billed using prolonged service codes like CPT Code 99354.

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.

9

Spravato Total Cost — Buy and Bill Insurance Model (21 Sessions)

This section shows your total out-of-pocket cost for 21 Spravato sessions under the Buy and Bill model, with estimates ranging from $9,450 to $630 depending on your plan and coverage timing.

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

Total Out-of-Pocket Cost (21 Sessions) — “Buy and Bill” Model

10

Spravato Per-Session Cost — Buy and Bill Model Breakdown

This section breaks down your estimated per-session Spravato cost under the Buy and Bill model, with visit prices ranging from $450 to $30 depending on your plan and deductible status.

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.

11

Key Assumptions Used in These Estimates

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.

12

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.

13

What You Need to Know About Spravato Costs—At a Glance

The whole cost logic in one fast, skimmable list.

  • ●


    Even if Spravato is covered, it can still be expensive. Coverage means insurance pays eventually—not that you skip the upfront hit.

  • ●


    Most people average about $250 per session—but that’s a median. Your number depends on your plan.

  • ●


    The first few sessions are usually the most expensive. If your deductible isn’t met, early visits can run around $1,800 before costs drop.

  • ●


    How your clinic bills the drug changes everything. “Buy & Bill” vs. “Specialty Pharmacy” can produce totally different totals—and your insurer picks the model.

  • ●


    Your plan type matters more than you think. PPOs and Gold HMOs usually protect you better; HDHPs front-load pain; flat copay plans are rare.

  • ●


    What you’ll pay comes down to four drivers:

    • 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 maximum

     

  • ●


    Manufacturer savings can slash medication costs if you have commercial insurance that covers Spravato.

  • ●


    Ask questions before you start. Get your clinic’s per-session charge, billing model, and how your plan processes claims. Surprises here cost real money.

14

How to Estimate Your Out-of-Pocket Costs (Step-by-Step)

This section gives you a step-by-step guide to estimating your Spravato costs with insurance—per session and in total—based on clinic billing model differences, your deductible, coinsurance, and where you are in your plan year.

If your insurance doesn’t cover Spravato, this won’t apply. But if it’s covered—even partially—this will help you forecast what you’ll still owe out of pocket before you commit to 21 sessions over six months.

What You’ll Need
  • Your health insurance card (or insurer portal login)
  • The name and phone number of your Spravato clinic
  • 10–15 minutes to ask the right questions
  • A notepad or screenshot app to keep a record

1
Look up your plan’s key numbers

You need four numbers:

  • Deductible — what you pay before insurance helps
  • Coinsurance — your percentage after the deductible
  • Out-of-pocket maximum — the most you’ll pay in a year
  • Copay vs. coinsurance — flat fee per visit or a percentage?

Find this in your plan summary or call the number on your insurance card.

2
Ask how your clinic bills Spravato

This one variable 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 + pharmacy)?”
  • “Can I speak to your billing coordinator?”

Buy and Bill usually means ~$1,800 billed per session. Specialty Pharmacy splits drug (~$600–$950) and clinic time (~$300–$750).

3
Estimate your first few sessions

If your deductible isn’t met, you’re paying full price upfront.

  • Buy and Bill: ~$1,400–$2,200 per session
  • Specialty Pharmacy: ~$900–$1,200 total per session

Example: with a $2,000 deductible, you may pay full price for 1–2 sessions before insurance starts sharing costs.

4
Calculate costs after the deductible

After your deductible, coinsurance applies.

Example: $1,800 session × 20% coinsurance = $360 per session until you hit your out-of-pocket max.

After the max, your cost may drop to $0–$30 per visit, depending on plan rules.

5
Check where you are in the plan year

Start in January and your deductible is probably untouched (higher early costs).
Start later in the year after other care and your costs can be dramatically lower.

6
Ask for a written estimate
  • “How many sessions are planned?”
  • “What’s the per-session charge?”
  • “Did you run a benefits investigation?”
  • “Can I get a written estimate of what I’ll owe?”

This isn’t being difficult. It’s preventing surprise bills that derail treatment.

7
Estimate your total for all 21 sessions

Multiply your expected per-session costs by 21.

If early sessions are high (e.g., $1,800) and later sessions drop to $30, use a blended average—or refer to the plan-based tables above.

Quick Estimate Tool
  • Look up your deductible
  • Assume ~$1,800/session until it’s met
  • Then assume ~$300/session with coinsurance
  • After your out-of-pocket max, assume $0–$30/session
  • Multiply each tier by how many sessions fall in that phase

It won’t be perfect—but it gets you most 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 estimate before we start?”

What to Watch Out For
  • The clinic can’t explain how they bill Spravato
  • They won’t tell you their per-session charge
  • They say “your insurance covers it” without checking benefits
  • They bill under hospital rates for outpatient sessions
  • They push you to start before confirming costs

Surprise bills are real. Good clinics help you avoid them.

Takeaway

This seven-step guide helps you estimate Spravato costs using your deductible, billing model, session charges, and plan-year timing—so you can avoid financial surprises before you start.

See the Evidence

Read the underlying evidence summary for this article on how commercial insurance covers Spravato, including what we analyzed, how we verified it, and when it was last updated.