Insurance Coverage for Ketamine Therapies: A Comprehensive Analysis of Coverage Patterns Among Major U.S. Health Insurers
A detailed analysis of ketamine therapy coverage policies across 18 major U.S. health insurance companies, covering over 85.8 million commercial plan members and documenting coverage patterns for Spravato (esketamine), IV ketamine, intramuscular ketamine, and oral ketamine treatments.
Who This Dataset Is For
Built for reporters, researchers, healthcare advocates, and care coordination teams who need clean, documented, downloadable data on insurance coverage patterns for ketamine-based mental health treatments, including detailed policy analysis, prior authorization requirements, and coverage exclusions across major U.S. commercial health plans.
Independent & Non-Commercial
This website carries no ads, sponsorships, affiliate links, or paid placements. We have no financial ties to anyone.
Verified Methodology
All policy citations refer to insurer-published documents (PDF or HTML) hosted on official insurer domains—clinical/medical policies, coverage guidelines, prior-authorization criteria, or provider bulletins—retrieved from the URLs recorded in the study dataset and accessed August 31, 2025. We also used the Centers for Medicare & Medicaid Services (CMS) Medical Loss Ratio (MLR) Public Use File, Reporting Year 2023
What You’re Downloading
18
Records Covered
36
Data Columns
16KB
File Size
CSV
File Format
Scope: Coverage analysis of 18 major U.S. health insurance companies representing 85.8+ million commercial plan members, with detailed policy documentation for Spravato (esketamine nasal spray), IV ketamine, intramuscular ketamine, and oral ketamine therapies. Created September 1, 2025.
Data Dictionary
parent_group_cov
Parent insurance company or health system
Parent insurance company or health system
brand_plan_cov
Brand name of the insurance plan or network
Brand name of the insurance plan or network
Share of Members_or_Enrollment
Percentage of national commercial insurance market share
Percentage of national commercial insurance market share
Estimated_Members
Estimated number of members covered by this plan
Estimated number of members covered by this plan
line_of_business
Type of insurance market (Commercial, Medicare, Medicaid)
Type of insurance market (Commercial, Medicare, Medicaid)
geography
Geographic coverage area (National, Multi-state, State-specific)
Geographic coverage area (National, Multi-state, State-specific)
policy_url
Direct link to official policy document
Direct link to official policy document
policy_title
Official title of the coverage policy document
Official title of the coverage policy document
policy_last_updated
Date when the policy was last updated by the insurer
Date when the policy was last updated by the insurer
last_verified
Date when policy information was last verified for this study
Date when policy information was last verified for this study
SPR_status
Spravato (esketamine) coverage status
Spravato (esketamine) coverage status
SPR_indications
Approved medical indications for Spravato coverage
Approved medical indications for Spravato coverage
SPR_pa_required
Whether prior authorization is required for Spravato
Whether prior authorization is required for Spravato
SPR_step_therapy
Step therapy requirements for Spravato
Step therapy requirements for Spravato
SPR_prescriber
Prescriber requirements or restrictions for Spravato
Prescriber requirements or restrictions for Spravato
SPR_rems_required
Risk Evaluation and Mitigation Strategy requirements
Risk Evaluation and Mitigation Strategy requirements
SPR_monitoring_time
Required monitoring time after Spravato administration
Required monitoring time after Spravato administration
SPR_site_of_care
Required site of care for Spravato administration
Required site of care for Spravato administration
SPR_benefit_channel
Which benefit covers Spravato (Medical vs Pharmacy)
Which benefit covers Spravato (Medical vs Pharmacy)
SPR_supply_model
How Spravato is supplied and distributed
How Spravato is supplied and distributed
SPR_codes_ref
Billing codes referenced for Spravato
Billing codes referenced for Spravato
SPR_exclusion_reason
Reason for exclusion if Spravato is not covered
Reason for exclusion if Spravato is not covered
SPR_policy_quote
Direct quote from policy regarding Spravato
Direct quote from policy regarding Spravato
IVK_status
IV ketamine coverage status
IV ketamine coverage status
IVK_exclusion_reason
Reason for IV ketamine exclusion
Reason for IV ketamine exclusion
IVK_policy_quote
Policy quote regarding IV ketamine
Policy quote regarding IV ketamine
IMK_status
Intramuscular ketamine coverage status
Intramuscular ketamine coverage status
IMK_exclusion_reason
Reason for intramuscular ketamine exclusion
Reason for intramuscular ketamine exclusion
IMK_policy_quote
Policy quote regarding intramuscular ketamine
Policy quote regarding intramuscular ketamine
ORK_status
Oral ketamine coverage status
Oral ketamine coverage status
ORK_exclusion_reason
Reason for oral ketamine exclusion
Reason for oral ketamine exclusion
ORK_policy_quote
Policy quote regarding oral ketamine
Policy quote regarding oral ketamine
doc_section_ref
Reference to specific section in policy document
Reference to specific section in policy document
year
CMS MLR reporting year for financial data
CMS MLR reporting year for financial data
life_years
Member life years from CMS MLR data
Member life years from CMS MLR data
earned_premium
Total earned premium from CMS MLR data
Total earned premium from CMS MLR data
Note: Dataset includes comprehensive coverage analysis for all four ketamine therapy types with detailed prior authorization requirements, step therapy protocols, prescriber restrictions, monitoring requirements, and financial data from CMS Medical Loss Ratio reports.
Data Preview – First 10 Rows, All Columns
Scroll horizontally to see all 36 columns with complete data. Full dataset in the download.
| parent_group_cov | brand_plan_cov | Share_of_Members | Estimated_Members | line_of_business | geography | policy_url | policy_title | policy_last_updated | last_verified | SPR_status | SPR_indications | SPR_pa_required | SPR_step_therapy | SPR_prescriber | SPR_rems_required | SPR_monitoring_time | SPR_site_of_care | SPR_benefit_channel | SPR_supply_model | SPR_codes_ref | SPR_exclusion_reason | SPR_policy_quote | IVK_status | IVK_exclusion_reason | IVK_policy_quote | IMK_status | IMK_exclusion_reason | IMK_policy_quote | ORK_status | ORK_exclusion_reason | ORK_policy_quote | doc_section_ref | year | life_years | earned_premium |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kaiser Foundation | Kaiser Permanente | 13.00% | 18,183,921 | Commercial | Multi-state | https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/spravato-nw-en.pdf | Clinical Oversight Review Board Criteria: Esketamine (Spravato) — Kaiser Foundation Health Plan of the Northwest | 2021-01 | 2025-08-27 | Covered_PA | MDD severe; multi-failure criteria | Yes | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Pharmacy | Not_Stated | Not_Stated | Not_Applicable | Non-formulary esketamine (Spravato) will be covered on the prescription drug benefit when the following criteria are met. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | CORB Criteria (1-page) | 2023 | 18,152,395.80 | $120,083,879,078.00 |
| Health Care Service Corporation (HCSC) | HCSC (BCBS IL/TX/NM/OK/MT) | 7.80% | 10,910,353 | Commercial | Multi-state (IL, TX, NM, OK, MT) | https://www.lumin.health/blue-cross-blue-shield-and-ketamine | Does Blue Cross Blue Shield cover ketamine treatment? | 2025-07-08 | 2025-08-29 | Covered | TRD | MDD | PA required | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | IV ketamine, IM ketamine, oral ketamine considered investigational | Ketamine infusions and ketamine injections are not determined to be safe or effective based on current evidence | Not_Covered | Investigational | Ketamine therapy is considered investigational | Not_Covered | Investigational | Ketamine therapy is considered investigational | Not_Covered | Investigational | Ketamine therapy is considered investigational | Main content | 2025 | Not_Stated | Not_Stated |
| UnitedHealth Group | UnitedHealthcare | 8.00% | 11,190,105 | Commercial | National | https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/ketalar-spravato.pdf | Ketalar® (Ketamine) and Spravato® (Esketamine) – Commercial Medical Benefit Drug Policy | 2025-05 | 2025-08-27 | Covered_PA | TRD (per policy criteria) | Yes | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Medical | Not_Stated | Not_Stated | Not_Applicable | Spravato is medically necessary for the treatment of treatment-resistant depression when all of the following criteria are met. | Excluded_Investigational | Psychiatric disorders investigational | Ketamine injection is investigational for psychiatric disorders, including depression. | Excluded_Investigational | Psychiatric disorders investigational | Ketamine injection is investigational for psychiatric disorders, including depression. | Not_Stated | Not_Stated | Not_Stated | Coverage Rationale (p.1–2) | 2023 | 11,241,218.90 | $64,277,284,898.90 |
| Elevance Health | Anthem Blue Cross Blue Shield (various states) | 5.90% | 8,252,703 | Commercial | Multi-state | https://files.providernews.anthem.com/3661/CC-0086_Pub-12-18-2023.pdf | Medical Drug Clinical Criteria: Spravato (esketamine) Nasal Spray (CC-0086) | 2023-12 | 2025-08-27 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | Yes | Not_Stated | Yes | 2h | Certified healthcare settings | Medical | Not_Stated | G2082; G2083; S0013 | Not_Applicable | Healthcare settings must be certified to provide Spravato; the individual must be monitored for at least 2 hours after administration. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Clinical Criteria; REMS/Monitoring (pp.1–2); Coding (p.2) | 2023 | 8,300,725.30 | $62,542,761,632.00 |
| CVS Health | Aetna | 5.00% | 6,993,816 | Commercial | National | https://www.aetna.com/cpb/medical/data/900_999/0950.html | Esketamine (Spravato) – Medical Clinical Policy Bulletins (CPB 0950) | 2025-02 | 2025-08-27 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Medical | Not_Stated | Not_Stated | Not_Applicable | Not_Stated | Excluded_Investigational | Experimental/investigational for depression | Aetna considers ketamine (intramuscular, intranasal, intravenous, oral, or subcutaneous) experimental, investigational, or unproven for the treatment of depression. | Excluded_Investigational | Experimental/investigational for depression | Aetna considers ketamine (intramuscular, intranasal, intravenous, oral, or subcutaneous) experimental, investigational, or unproven for the treatment of depression. | Excluded_Investigational | Experimental/investigational for depression | Aetna considers ketamine (intramuscular, intranasal, intravenous, oral, or subcutaneous) experimental, investigational, or unproven for the treatment of depression. | CPB 0950: Policy; CPB 0938: Policy | 2023 | 7,007,257.90 | $44,510,221,312.70 |
| GuideWell | Florida Blue | 3.80% | 5,315,300 | Commercial | State (FL) | https://provider.floridablue.com/content/dam/provider/documents/clinical-resources/medical-coverage-guidelines/medical-necessity/esketamine-spravato-nasal-spray.pdf | Esketamine (Spravato®) Nasal Spray — Medical Coverage Guideline 09-J3000-37 | 2025-02 | 2025-08-27 | Covered | TRD; MDD with acute suicidal ideation/behavior | No | Not_Stated | Not_Stated | Yes | Not_Stated | Certified healthcare settings | Medical | Not_Stated | Not_Stated | Not_Applicable | Coverage for esketamine (Spravato®) nasal spray is considered medically necessary when all the following criteria are met. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Medical Necessity Criteria (pp.1–2) | 2023 | 5,342,414.10 | $35,103,949,325.30 |
| The Cigna Group | Cigna Healthcare | 4.20% | 5,874,805 | Commercial | National | https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_psychiatry_spravato_prior_authorization_policy.pdf | Psychiatry – Spravato Prior Authorization Policy | 2025-05 | 2025-08-27 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Medical | Not_Stated | Not_Stated | Not_Applicable | Spravato will be approved for coverage when the following criteria are met. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Prior Authorization Policy (pp.1–3) | 2023 | 5,866,946.90 | $35,883,325,451.70 |
| Centene | Ambetter (various states) | 2.90% | 4,056,413 | Commercial | Multi-state | https://www.centene.com/content/dam/centeneweb/members/pdfs/2024/Esketamine-Policy.pdf | Clinical Policy: Esketamine (Spravato) (CP.PMN.199) | 2024-10 | 2025-08-27 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | Yes | Not_Stated | Yes | 2h | Certified healthcare settings | Medical | Not_Stated | Not_Stated | Not_Applicable | Esketamine (Spravato) may be considered medically necessary when all of the following criteria are met. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Policy Statement; Clinical Criteria (pp.1–2) | 2023 | 4,087,007.20 | $23,540,633,928.90 |
| Highmark | Highmark Blue Cross Blue Shield | 1.80% | 2,517,774 | Commercial | Multi-state (PA, DE, WV) | https://www.highmarkprc.com/hmk2/pdf/providers/guidelines/medicalpolicy/i-212-007-esketamine-spravato.pdf | Esketamine (Spravato) — Policy I-212-007 (Commercial Medical Policy — Pennsylvania) | 2025-03 | 2025-08-27 | Covered | TRD; MDD with acute suicidal ideation/behavior | No | Not_Stated | Not_Stated | Yes | Not_Stated | Certified healthcare settings | Medical | Not_Stated | Not_Stated | Not_Applicable | Esketamine (Spravato) is considered medically necessary when all of the following criteria are met. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Medical Necessity (pp.1–2) | 2023 | 2,527,952.00 | $16,951,799,522.80 |
| Blue Cross and Blue Shield of North Carolina | Blue Cross NC | 1.60% | 2,238,021 | Commercial | State (NC) | https://www.bluecrossnc.com/content/dam/bcbsnc/pdf/providers/utilization-management/prior-authorization-forms/esketamine-spravato-nasal-spray.pdf | esketamine (Spravato) Nasal Spray — Prior Review/Certification Request for Services Form | 2024-12 | 2025-08-27 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | Yes | Not_Stated | Yes | 2h | Certified healthcare settings | Medical | Not_Stated | Not_Stated | Not_Applicable | Treatment must be provided in a certified healthcare setting and the member must be monitored for at least 2 hours after administration. | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Not_Stated | Prior Authorization Form (pp.1–2) | 2023 | 2,245,577.60 | $15,659,903,063.30 |
← Scroll left and right to see all 36 columns →
✅ Quality Controls
✓
Source Verification: All policy information extracted directly from official insurer websites and policy documents, with URLs verified and accessible as of August 31, 2025
Source Verification: All policy information extracted directly from official insurer websites and policy documents, with URLs verified and accessible as of August 31, 2025
✓
Market Share Validation: Member enrollment figures cross-referenced with CMS Medical Loss Ratio Public Use Files (Reporting Year 2023) for accuracy
Market Share Validation: Member enrollment figures cross-referenced with CMS Medical Loss Ratio Public Use Files (Reporting Year 2023) for accuracy
✓
Coverage Status Standardization: Consistent categorization system applied across all insurers (Covered, Covered_PA, Excluded, etc.) based on policy language analysis
Coverage Status Standardization: Consistent categorization system applied across all insurers (Covered, Covered_PA, Excluded, etc.) based on policy language analysis
✓
Data Completeness: All 18 major insurers representing over 85.8 million members included with comprehensive coverage details for all four ketamine therapy types
Data Completeness: All 18 major insurers representing over 85.8 million members included with comprehensive coverage details for all four ketamine therapy types
Download the Dataset
Attribution Required: I agree to attribute and link back to this page when reusing the dataset (CC BY 4.0)
Also available at Zenodo: 10.5281/zenodo.17021491 — Version 1.0.0 — Last updated: September 1, 2025
Required Attribution
Credit Michael Alvear and link to this page: https://ketaminetherapyfordepression.org/datasets/insurance-coverage-for-ketamine-therapies
About the author: Independent researcher/patient advocate focused on healthcare costs and access.
How to Cite
Alvear, M. (2025, August 31). Insurance coverage for esketamine and ketamine therapies in major U.S. commercial plans: Cross-sectional policy analysis of 18 insurers. https://ketaminetherapyfordepression.org/datasets/insurance-coverage-for-ketamine-therapies/ (Version 1.0). Zenodo: 10.5281/zenodo.17021491
BibTeX and other formats available after Zenodo download
Quick Usage Examples
- Analyze coverage disparities between major insurers for investigative reporting
- Research prior authorization barriers for healthcare access studies
- Benchmark insurance policies for healthcare advocacy organizations
- Support care coordination and patient navigation services
Technical Details
File Access
- Opens in Excel, Google Sheets, or any data tool
- UTF-8 encoding, comma-separated values
- No macros or executable content
- Served over HTTPS with file hash verification
Import Instructions
- Excel: Import as UTF-8, comma-separated
- Google Sheets: File → Import → Upload
- Python:
pd.read_csv('file.csv')
⚠️ Known Limitations
- Information reflects published data as of the “Last updated” date
- This is not an official government site
- Policy interpretation may vary by individual plan and state regulations