Medicaid Ketamine Therapy Coverage Database: 50-State Policy Analysis & Enrollment Data
Comprehensive coverage policy information for ketamine therapy across Medicaid plans in all 50 states plus DC, detailing coverage status, requirements, and exclusions for different ketamine formulations including Spravato (nasal spray), IV, IM, and oral ketamine.
This dataset provides plan-level analysis across Fee-for-Service and Managed Care Organizations with policy documentation and enrollment data.
Who This Dataset Is For
Built for reporters, researchers, healthcare advocates, and care coordination teams who need clean, documented, downloadable data on Medicaid ketamine therapy coverage policies, prior authorization requirements, step therapy protocols, prescriber restrictions, and site-of-care limitations across all U.S. states and territories.
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 state Medicaid agency or Medicaid MCO documents (PDF/HTML) hosted on official government or plan domains—clinical/medical policies, PDL/PA criteria/forms, provider bulletins, and billing/billing-manual guidance—retrieved from the exact URLs recorded in the dataset and last accessed September 2, 2025. For each state (plus DC when included) we captured the controlling FFS document, added MCOs until ~80% of enrollment was represented, and included PBM/carve-out controllers where pharmacy/behavioral benefits are centralized.
What You’re Downloading
Scope: Complete coverage of all 50 U.S. states plus District of Columbia, representing Fee-for-Service Medicaid programs and Managed Care Organizations covering approximately 80% of each state’s Medicaid enrollment. Created September 2, 2025.
Data Dictionary
Two-letter state/territory abbreviation (e.g., CA, TX, DC)
Classification of Medicaid organization (State_Agency, MCO, etc.)
Parent organization name (State Medicaid Agency, health plan group)
Specific plan or program name providing coverage
Direct URL to official policy document
Official title of the policy document
When the policy document was last updated (YYYY-MM format)
Date when data was last verified and extracted (YYYY-MM-DD)
Coverage status for Spravato (esketamine nasal spray): Covered_PA, Not_Covered, etc.
Approved medical indications for Spravato (TRD, MDD with suicidal ideation, etc.)
Whether prior authorization is required for Spravato (Yes/No)
Required step therapy or treatment history before Spravato coverage
Prescriber specialty requirements for Spravato (Psychiatrist, etc.)
Whether REMS (Risk Evaluation and Mitigation Strategy) compliance is required
Required monitoring period after Spravato administration
Required site of care for Spravato administration (REMS certified site, clinic, etc.)
Benefit classification for coverage (Medical, Pharmacy)
How Spravato is supplied (specialty pharmacy, provider-administered, etc.)
Relevant billing codes for Spravato (HCPCS, NDC references)
Specific reason if Spravato is excluded from coverage
Direct quote from policy document regarding Spravato coverage
Coverage status for IV ketamine infusions
Specific reason if IV ketamine is excluded from coverage
Direct quote from policy document regarding IV ketamine
Coverage status for intramuscular ketamine injections
Specific reason if IM ketamine is excluded from coverage
Direct quote from policy document regarding IM ketamine
Coverage status for oral ketamine formulations
Specific reason if oral ketamine is excluded from coverage
Direct quote from policy document regarding oral ketamine
Page or section reference within the source policy document
Batch identifier for data extraction process tracking
Note: Fields with “Not_Stated” values indicate information was not explicitly stated in the source policy document. All coverage statuses and requirements are extracted directly from official Medicaid policy documents.
Data Preview
Scroll horizontally to see all columns. Full dataset in the download.
| geography | entity_type | parent_group | brand_plan | policy_title | policy_last_updated | SPR_status | SPR_indications | SPR_pa_required | SPR_step_therapy | IVK_status | IMK_status | ORK_status |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AK | State_Agency | State Medicaid Agency | Alaska Medicaid | Alaska Medicaid Prior Authorization Criteria — Spravato (esketamine) | 2023-01 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants + augmentation | Not_Stated | Not_Stated | Not_Stated |
| AL | State_Agency | State Medicaid Agency | Alabama Medicaid | Alabama Medicaid Preferred Drug List | 2024-07 | Covered_PA | Not_Stated | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated |
| AL | MCO | UnitedHealth Group | UnitedHealthcare Community Plan of Alabama | UnitedHealthcare Community Plan Clinical Policy: Esketamine (Spravato) | 2024-05 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants | Not_Covered | Not_Covered | Not_Covered |
| AR | State_Agency | State Medicaid Agency | Arkansas Medicaid | Arkansas DHS Medicaid Preferred Drug List | 2024-07 | Covered_PA | Not_Stated | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated |
| AZ | MCO | Aetna | Aetna Better Health of Arizona | Aetna Better Health Clinical Policy Bulletin: Esketamine | 2024-04 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants | Not_Covered | Not_Covered | Not_Covered |
| AZ | MCO | UnitedHealth Group | UnitedHealthcare Community Plan of Arizona | UnitedHealthcare Community Plan Clinical Policy: Esketamine (Spravato) | 2024-05 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants | Not_Covered | Not_Covered | Not_Covered |
| AZ | MCO | Molina Healthcare | Molina Healthcare of Arizona | Molina Clinical Policy: Esketamine (Spravato) | 2024-06 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants | Not_Covered | Not_Covered | Not_Covered |
| CA | State_Agency | State Medicaid Agency | Medi-Cal (California Medicaid) | Medi-Cal Rx Formulary and Prior Authorization Criteria | 2024-01 | Covered_PA | TRD; MDD with acute suicidal ideation/behavior | Yes | >=2 antidepressants | Not_Stated | Not_Stated | Not_Stated |
| CA | MCO | Kaiser Foundation | Kaiser Foundation Health Plan (Northern California) | Kaiser Permanente Drug Formulary | 2024-01 | Covered_PA | Not_Stated | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated |
| CA | MCO | Kaiser Foundation | Kaiser Foundation Health Plan (Southern California) | Kaiser Permanente Drug Formulary | 2024-01 | Covered_PA | Not_Stated | Yes | Not_Stated | Not_Stated | Not_Stated | Not_Stated |
← Scroll left and right to see all columns →
✅ Quality Controls
Source Document Verification: All policy citations refer to official government or health plan documents hosted on verified domains, with exact URLs recorded for each entry.
Coverage Representativeness: For each state, Fee-for-Service programs plus Managed Care Organizations representing approximately 80% of total Medicaid enrollment are included.
Multi-Formulation Analysis: Comprehensive coverage analysis across all ketamine formulations: Spravato (nasal spray), IV infusion, intramuscular injection, and oral preparations.
Systematic Data Extraction: Structured extraction process with batch tracking ensures consistency and traceability across all 165 records and 32 data fields.
Download The Medicaid Ketamine Therapy Coverage Database: 50-State Policy Analysis & Enrollment Data
There are 3 Separate Data Files:
medicaid_state_mco_enrollment_2022_vs_latest.csv: This file contains plan-level Medicaid managed care organization enrollment data comparing 2022 figures to the latest month, showing market shares and enrollment numbers across different states and health plans.
medicaid_state_summary_mco_vs_total.csv: This file provides state-level summary statistics comparing total MCO enrollment from 2022 to overall state Medicaid enrollment in the latest month, with calculated ratios.
medicaid_ketamine_therapy_coverage_policies_50states_v20250902.csv: This file contains comprehensive coverage policy information for ketamine therapy across Medicaid plans in all 50 states, detailing coverage status, requirements, and exclusions for different ketamine formulations (nasal spray, IV, IM, and oral).
Download Agreement
By downloading you agree to cite “Michael Alvear” and link back to this page: https://ketaminetherapyfordepression.org/datasets/medicaid-ketamine-coverage-policies
Required Attribution
About the author: Independent researcher/patient advocate focused on healthcare costs and access.
How to Cite
BibTeX and other formats available after Zenodo download
Quick Usage Examples
- Analyze state-by-state Spravato coverage requirements and prior authorization criteria
- Compare step therapy protocols across different health plans and MCOs
- Research prescriber specialty requirements and REMS compliance variations
- Identify coverage gaps for off-label ketamine formulations (IV, IM, oral)
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 implementation may vary at the provider level
⚖️ License & Usage
CC BY 4.0: Free to use, modify, and redistribute with attribution
This dataset is for educational and operational planning—not medical or legal advice.
Corrections & Updates
See something that needs fixing? Help improve this dataset for everyone.
Email us with the state name, column, and suggested correction. We review and update with attribution in the changelog.
Update Schedule
We aim to review correction requests within 7 business days and publish updates monthly or sooner when critical changes are reported.