How Much Does Spravato Cost With & Without Insurance? 2025 Cost Guide + Calculator
By Michael Alvear, Health Author & Independent Researcher
My research is published on these scholarly platforms:
Last Updated:
VIEW THESE COSTS IN ONE COMPARISON TABLE
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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. |
What Does Spravato Cost With Insurance?
14 essential sections to estimate, compare, and lower your out-of-pocket costs
Can’t Decide Between IV, Injections, Or Spravato?
Use My Decision Table
This report ranks all three options—IV, injection, and Spravato—on effectiveness, cost, fastest relief, and more, giving you a clear framework to decide.
Downloads as PDF • 5 minute read
Spravato Insurance Cost Calculator
* Spravato is FDA-approved as a 21-session treatment (+ maintenance as needed). We’ll show your estimated total for all 21 sessions and the average cost per session.
How To Get The Most Out of The Spravato Insurance Calculator
My insurer wouldn’t tell me what Spravato would cost—so I built a tool to find out. Here’s how to get the most out of my calculator:
- The Problem With Most Spravato Price Estimates—And How This Calculator Fixes It
- How the Month You Start Spravato Affects Your Total Cost
- How the Spravato withMe Savings Program Changes Your Medication Costs
- Where Our Numbers Come From—and Why They’re Closer to What You’ll Really Pay
Why We Didn’t Build a Pharmacy Benefit Calculator
- Important Disclaimers
- Email This Calculator To Someone You Care About
- Link to This Free Tool So Your Readers Know Exactly What Spravato Will Cost Them
Can’t Decide Between IV, Injections, Or Spravato?
Use My Decision Table
This report ranks all three options—IV, injection, and Spravato—on effectiveness, cost, fastest relief, and more, giving you a clear framework to decide.
Downloads as PDF • 5 minute read
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.
See full breakdown
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.
See full breakdown
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.
Not sure if Spravato is worth the cost?
I reviewed 33 systematic studies so you can see how well it works—how many people enter remission, how fast it takes effect, and which methods perform best.
How Can You Be Sure Ketamine Therapy Actually Works?
I pulled together 33 systematic reviews from the last five years into one report—so you don’t have to rely on hype, guesses, or anecdotes. This is the highest level of real-world evidence we have.
Inside My Report You’ll Find
- What percent of patients enter remission—broken down by delivery method
- Which method is most effective—IV, injection, or Spravato nasal spray
- How fast ketamine can work to reduce or end symptoms
- Which combinations (like psychotherapy) may enhance response
- And a lot more…
Verified by the Platforms That Matter
This research summary report has been published across four trusted platforms that host peer-reviewed or open science content, including:
– Published ketamine research on Zenodo
– Ketamine evidence summary hosted on SSRN
– Scientific report on ketamine outcomes on Figshare
– Evidence-based ketamine therapy report on OSF
View the PDF Report Here:
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.
PEER-VALIDATED KETAMINE RESEARCH
SSRN (Academic Research Network)
Frequently Asked Questions About Spravato Costs
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.
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.
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
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.
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.
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.
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.