Spravato (esketamine nasal spray) costs between roughly $880 and $1,320 per session for the drug alone, depending on the dose. But that’s just the medication. Because Spravato must be administered in a certified healthcare setting with a two-hour monitoring period, the total out-of-pocket cost per visit is higher once facility and observation fees are factored in. Over a full course of treatment, the total can reach tens of thousands of dollars.
Cost Per Session by Dose
Spravato comes in single-use nasal spray devices, each containing 28 mg. A treatment session uses either two or three devices depending on your prescribed dose. At current retail pricing, the 56 mg dose (two devices) starts around $882, while the 84 mg dose (three devices) starts around $1,319. Most patients begin at 56 mg for their first session, then move to 84 mg if tolerated and needed.
These prices reflect the medication cost only. Each session also requires supervised administration at a REMS-certified clinic or hospital outpatient facility, where you’ll stay for at least two hours of monitoring. Facility fees, provider observation charges, and any additional lab work add to the bill. Clinics that offer Spravato sometimes quote an all-in per-session price, so it’s worth asking for the total rather than just the drug cost.
Total Cost Over a Treatment Course
Spravato treatment follows a set schedule that starts intensive and tapers down:
- Weeks 1 through 4 (induction): Two sessions per week, for a total of eight sessions. At the 84 mg dose, that’s roughly $10,500 in drug costs alone for the first month.
- Weeks 5 through 8: One session per week, totaling four sessions.
- Week 9 and beyond (maintenance): One session every one to two weeks, adjusted based on how well your symptoms are controlled.
For someone who stays on the 84 mg dose, the drug cost for the first two months alone could exceed $15,000 before facility fees. Maintenance treatment continues indefinitely for many patients, with costs of roughly $2,600 to $5,300 per month in medication depending on whether you’re dosed weekly or every two weeks. Over a full year, total drug costs can easily surpass $40,000.
What Insurance Typically Covers
Most commercial insurers and Medicare Part B do cover Spravato, but with significant restrictions. You’ll almost certainly need prior authorization before your first session. A representative policy from Blue Shield of California illustrates what insurers commonly require: you must be at least 18, have a diagnosis of treatment-resistant depression, have tried and failed at least two different antidepressants, be taking an oral antidepressant alongside Spravato, and have the treatment prescribed by or in consultation with a psychiatrist.
Medicare covers Spravato under Part B (since it’s administered in a medical setting rather than dispensed at a pharmacy). CMS guidelines allow up to eight sessions in the first month, four in the second month, and four per month thereafter. Sessions exceeding those limits can trigger medical review. Your Part B coinsurance (typically 20%) still applies, which means even with Medicare coverage, the monthly out-of-pocket cost during induction could be several hundred dollars or more.
With commercial insurance, copays vary widely. Some patients report copays in the $10 to $150 range per session after coverage kicks in. Others face much higher cost-sharing depending on their plan’s formulary tier and deductible structure. Janssen, the manufacturer, offers a savings program for commercially insured patients that can reduce per-session costs, though eligibility requirements apply and the program doesn’t cover government-insured patients.
How Spravato Compares to IV Ketamine
Generic intravenous ketamine, used off-label for depression, is dramatically cheaper as a raw drug. The medication itself costs only a few dollars per infusion. A Canadian pharmacoeconomic analysis found weekly drug costs of roughly $5 to $16 for IV ketamine, compared to $1,092 to $1,365 for Spravato during the induction phase. Even after adding clinic and infusion fees, a single IV ketamine session in the U.S. typically runs $400 to $800.
The tradeoff is insurance coverage. Because IV ketamine for depression is off-label, most insurers won’t pay for it, meaning the full cost comes out of pocket. Spravato, as an FDA-approved treatment, has a clearer path to insurance reimbursement. For patients whose insurance covers Spravato with manageable copays, it can actually end up cheaper month to month than paying cash for ketamine infusions. For those without coverage or with high cost-sharing, IV ketamine is often the less expensive option.
Reducing Your Out-of-Pocket Costs
If you’re facing high costs, a few practical steps can help. Start by calling the Spravato support line run by the manufacturer, which can connect you to copay assistance programs or patient assistance for uninsured individuals. Ask your prescribing clinic whether they have experience navigating prior authorization for your specific insurer, since denials are common and appeals often succeed with proper documentation of failed antidepressant trials.
If your commercial insurance denies coverage, request the denial in writing and ask your psychiatrist to submit a peer-to-peer review or formal appeal. Many initial denials are overturned when clinical records clearly show two or more failed antidepressant courses. Some clinics also offer bundled pricing for self-pay patients that includes the drug, administration, and monitoring in a single fee, which can be significantly less than the sum of itemized charges.