Does Your Insurance Cover Ketamine?

Spravato (esketamine) is the only FDA-approved ketamine-based treatment for depression. As an FDA-approved medication, it is covered by most major insurance plans, including Medicare and many Medicaid programs.

IV ketamine infusions, IM injections, and sublingual formulations are used off-label and are generally not covered by insurance. Patients typically pay out-of-pocket, with some clinics offering payment plans and financing.

Many insurers require prior authorization before covering Spravato. This means your doctor must submit documentation showing medical necessity, including failed trials of other antidepressants, before treatment is approved.

Insurance coverage for ketamine treatments varies significantly by state. Some states have parity laws requiring mental health coverage, while Medicaid programs differ in their formulary decisions and prior authorization requirements.