When is IV Ketamine Self-Pay Cheaper Than Spravato with Insurance?
Click your deductible below | Assumes treatment starts in January (deductible not yet met)
How We Chose These Insurance Scenarios
Why These Specific Deductibles and Out-of-Pocket Maximums? We based these seven scenarios on national median data showing the most common insurance plan structures Americans actually have. Our goal was simplicity while covering the realistic range of plans you’re likely to encounter.
Why January Start Date? All scenarios assume treatment starts in January with your annual deductible not yet met. This represents the most conservative cost estimate and the most common planning scenario—most people research treatment costs before starting therapy.
What We Can’t Account for: We recognize these comparisons would change dramatically based on factors like: (1) whether you’ve already met part or all of your deductible, (2) when you start treatment during the year (starting in October means your benefits reset in January mid-treatment), (3) your specific insurance carrier’s pricing agreements, and (4) dozens of other variables unique to your situation.
The Reality: Creating a tool that accounts for all possible timing scenarios and partial deductible situations would require a book-length webpage. It’s simply not feasible to model every combination while keeping this information digestible.
What You Should Do: Use these comparisons as a starting point, but always verify costs with your insurance company. Better yet, have your ketamine clinic verify costs when they submit your prior authorization—they have experience navigating insurance complexities and can give you an accurate estimate for your specific situation.
How We Estimated the Number of Sessions for IV Ketamine and Spravato
IV Ketamine: IV ketamine doesn’t have a schedule protocol for depression, so the number of infusions is individualized—based on how you respond and whether you need ongoing maintenance. For this cost comparison (to keep it simple and understandable), we model ~11 infusions for a typical course and ~18 infusions for higher-need / harder-to-treat cases. A small minority of patients receive more, but we don’t include the long tail in the “typical” estimate.
Spravato: Spravato is different: its FDA labeling uses a structured schedule (twice weekly early on, then weekly, then weekly or every other week). Over the first six months that commonly works out to about ~21 supervised sessions, but real-world care often goes beyond the minimum schedule. For apples-to-apples cost planning, we model ~25 sessions as a typical real-world total and ~35 sessions for higher-need cases, with a smaller subset requiring more than 35.
By Michael Alvear, Health Author & Independent Researcher
My research is published on these scholarly platforms:
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Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $1,450
IV: $4,950
IV saves $750
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
Spravato saves $50
IV: $4,950
IV saves $750
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $3,200
IV: $8,100
Spravato saves $2,400
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $1,575
IV: $4,950
IV saves $50
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
Spravato saves $225
IV: $4,950
IV saves $50
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $3,375
IV: $8,100
Spravato saves $3,100
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $1,200
IV: $4,950
IV saves $1,050
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
IV saves $300
IV: $4,950
IV saves $1,050
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $2,850
IV: $8,100
Spravato saves $2,100
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $850
IV: $4,950
IV saves $2,050
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
IV saves $790
IV: $4,950
IV saves $2,050
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $2,360
IV: $8,100
Spravato saves $1,100
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $450
IV: $4,950
IV saves $3,050
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
IV saves $1,350
IV: $4,950
IV saves $3,050
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $1,800
IV: $8,100
Spravato saves $100
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
Spravato saves $50
IV: $4,950
IV saves $3,550
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
IV saves $1,910
IV: $4,950
IV saves $3,550
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $1,240
IV: $8,100
IV saves $400
Typical Treatment
11 IV vs 25 Spravato sessions
IV: $4,950
IV saves $350
IV: $4,950
IV saves $4,050
Typical IV, High-Need Spravato
11 IV vs 35 Spravato sessions
IV: $4,950
IV saves $2,470
IV: $4,950
IV saves $4,050
High-Need Both
18 IV vs 35 Spravato sessions
IV: $8,100
Spravato saves $680
IV: $8,100
IV saves $900
Why Session Counts Matter
Research consistently shows IV ketamine has 2-5x higher efficacy than intranasal Spravato in placebo-controlled studies, likely due to 100% bioavailability (vs 48% for nasal spray) and the full racemic molecule (both mirror-image forms vs just one). This means:
High-need maintenance: 18 sessions for extended stability
High-need maintenance: 35+ sessions for extended stability
The cost comparisons below show three clinically relevant scenarios: (1) Typical IV vs Typical Spravato, (2) Typical IV vs High-Need Spravato, and (3) High-Need IV vs High-Need Spravato.
Why we use $450 as the baseline IV package price and 25/35 sessions for Spravato
The IV Pricing Challenge: We can’t predict your exact local IV cost — and that’s actually the industry’s reality, not a limitation of this analysis.
Why geographic tiers don’t work: We initially considered breaking markets into tiers by population (using Combined Statistical Areas) — Top 10 metros, mid-tier cities, smaller markets. But market size doesn’t predict pricing. A smaller city with only two ketamine clinics (low competition) can charge as much as Miami or Atlanta. Meanwhile, Denver has intense clinic competition that drives prices below what you’d expect for a high-cost-of-living city. Hartford, a mid-sized market, can have monopoly pricing higher than Chicago simply because there are fewer providers.
What actually drives IV ketamine pricing: Provider density and local competition matter far more than population or cost-of-living. A city of 500,000 with eight ketamine clinics will have lower prices than a city of 2 million with three clinics.
Why $450 per session (with package discount): Based on 2024-2025 market research, IV ketamine package pricing typically falls into these ranges after standard discounts (we assume 18%, typical for 8-12 session packages):
- Premium markets (NYC, SF, LA, Seattle, Boston): $550-800/session
- Competitive metros (most major cities): $400-600/session
- Value markets (smaller cities, high competition): $300-450/session
We use $450 as the baseline because it represents the midpoint of typical package pricing across most U.S. markets. This won’t be precise for your specific area, but it gives you directionally correct guidance.
Why 25/35 sessions for Spravato (not the “21-session protocol”): The FDA-approved “21-session protocol” is a regulatory baseline designed to fit a six-month clinical trial window — not a medical ceiling. Real-world evidence shows that 21 sessions represents the floor (minimum to observe efficacy), not where most patients achieve stability. Independent real-world data indicates the therapeutic “sweet spot” for stability typically occurs between 25-35 sessions. The 21-session number comes from trial design constraints, not from where patients actually stop treatment. For successful responders, extended maintenance (25-35+ sessions) is standard clinical practice to “lock in gains” and reduce relapse probability.
The bottom line: These comparisons are ballpark estimates for planning purposes. If your area runs significantly higher or lower than $450, the break-even points will shift accordingly — but the overall pattern of “when IV wins vs when Spravato wins” remains consistent.
Complete Comparison: All Scenarios at a Glance
Green = IV wins | Red = Spravato wins | Yellow = Close (<$500 difference)
IV Wins
Spravato Wins
Close Call
WITH Manufacturer Assistance
| Deductible | Typical Both (11 IV vs 25 Spravato) |
Typical IV, High Spravato (11 IV vs 35 Spravato) |
High-Need Both (18 IV vs 35 Spravato) |
|---|---|---|---|
| $0-$1,999 | Spravato saves $1,450 |
Nearly identical Spravato saves $50 |
Spravato saves $3,200 |
| $2,000 | Spravato saves $1,575 |
Close Spravato saves $225 |
Spravato saves $3,375 |
| $3,000 | Spravato saves $1,200 |
Close IV saves $300 |
Spravato saves $2,850 |
| $4,000 | Spravato saves $850 |
IV saves $790 |
Spravato saves $2,360 |
| $5,000 | Close Spravato saves $450 |
IV saves $1,350 |
Spravato saves $1,800 |
| $6,000 | Nearly identical Spravato saves $50 |
IV saves $1,910 |
Spravato saves $1,240 |
| $7,000 | Close IV saves $350 |
IV saves $2,470 |
Close Spravato saves $680 |
Spravato wins most scenarios when you have manufacturer help. The “deductible cliff” starts around $4k-5k.
WITHOUT Manufacturer Assistance
| Deductible | Typical Both (11 IV vs 25 Spravato) |
Typical IV, High Spravato (11 IV vs 35 Spravato) |
High-Need Both (18 IV vs 35 Spravato) |
|---|---|---|---|
| $0-$1,999 | IV saves $750 |
IV saves $750 |
Spravato saves $2,400 |
| $2,000 | Nearly identical IV saves $50 |
Nearly identical IV saves $50 |
Spravato saves $3,100 |
| $3,000 | IV saves $1,050 |
IV saves $1,050 |
Spravato saves $2,100 |
| $4,000 | IV saves $2,050 |
IV saves $2,050 |
Spravato saves $1,100 |
| $5,000 | IV saves $3,050 |
IV saves $3,050 |
Nearly identical Spravato saves $100 |
| $6,000 | IV saves $3,550 |
IV saves $3,550 |
Close IV saves $400 |
| $7,000 | IV saves $4,050 |
IV saves $4,050 |
IV saves $900 |
Without manufacturer help, IV dominates. The only exception is high-need scenarios (18 vs 35 sessions) with low-to-mid deductibles, where Spravato’s insurance coverage helps.
🎯 The Clear Winner
Manufacturer assistance makes or breaks the comparison. With it, Spravato is competitive. Without it, IV self-pay wins across most scenarios—especially with deductibles $4k+.
The visual pattern is clear: more green (IV wins) as you move down the rows without manufacturer help.
How “Covered” Spravato Can Cost You More Than Self-Pay IV Ketamine
The word “covered” is one of the most expensive traps in American mental health.
Most patients assume that if their insurance covers Spravato (nasal esketamine) but not IV ketamine, that means Spravato will be cheaper. They hear “covered” and think “free.” They hear “not covered” and think “impossible.”
In many cases, the opposite is true. Because of high deductibles, the number of sessions required, and hidden time costs, you may spend less by paying cash for IV ketamine.
Reality Check: Find Your Scenario
Use the comparison tool above to see where your plan lands. “Covered” Spravato often pushes you to your full out-of-pocket maximum, while a shorter course of IV ketamine may cost less than your deductible.
The System Is Upside Down
If you ran the numbers and felt angry, you’re not overreacting. This is what unfairness looks like inside a billing system.
The FDA-approved version of ketamine is the version that could be patented. The version many clinics consider more effective—generic IV ketamine—often gets treated like it doesn’t exist.
1. The Mirror-Image Problem: Fighting With One Hand Tied
Many experts believe generic IV ketamine works better because it is racemic—it contains two mirror-image molecules (R and S) that work together.
IV ketamine: Both hands free. Full toolkit.
Spravato: Only one half (the S-molecule). One hand tied behind your back.
The patent worked out for the manufacturer. The patient got the narrower version.
2. The Bioavailability Paradox
IV ketamine is 100% bioavailable. Every drop goes to work. Spravato is a nasal spray with about half that. A big chunk is swallowed or lost. If less of the drug lands, the protocol makes up for it with more sessions.
3. The Life-Disruption Tax: The Pain Insurance Doesn’t Count
Because Spravato is less efficient per session, the early protocol can require 21 to 30 visits in the first few months. That creates costs no insurance calculator sees:
- Job pressure: You can’t vanish for 30 half-days without someone noticing. People get pushed into awkward disclosures just to stay employed.
- PTO burn: You spend your vacation time in a clinic chair. When you finally feel better, your time off is already gone.
- Childcare costs: Dozens of clinic visits means dozens of hours someone has to cover your kids—none of that shows up in “covered.”
- Lost wages: If you’re hourly or freelance, “covered” can quietly become $5,000 to $10,000 in income you never get back.
4. The “Covered” Option Can Corner You
Insurance doesn’t offer options. It sets the menu. If the only thing they’ll pay for is the slow, visit-heavy protocol—and the faster route is cash—then “covered” isn’t a gift. It can be a financial and logistical squeeze that hits you when you’re least able to fight back.
Bottom Line
Don’t assume “covered” means “cheaper.” Run the math, count the time, and price the disruption. The comparison tool above shows you when IV self-pay actually costs less.