Spravato Insurance Cost Calculator

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.

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.

(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.

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.