Medicare and Spravato™ (Esketamine) – Is It Covered?
Does Medicare cover Spravato™ (Esketamine)?
Medicare may cover Spravato treatment — but approval depends on your specific Medicare plan type, diagnosis, and whether all required medical-necessity and safety criteria are met. At Libertas Mind, we help patients verify their Medicare benefits and complete prior authorization when needed so they can access Spravato treatment smoothly.
Medicare treats Spravato as a medical therapy (not a typical take-home prescription), and coverage is only granted under strict conditions.
Medicare Spravato™ (Esketamine) Coverage Requirements
For Spravato to be covered under Medicare, most plans (including Original Medicare and many Medicare Advantage plans) will require that all of the following conditions be met:
- Eligibility & Diagnosis
- Patient is 18 years or older and eligible for Medicare.
- Patient has a diagnosis of either:
Treatment-resistant depression (TRD) — defined as failure of at least two antidepressant trials from different classes at adequate dose and duration; or
Major depressive disorder (MDD) with acute suicidal ideation or behavior.
- Treatment History & Documentation
Medical records must show prior inadequate response to at least two antidepressants from different classes, or documented unsuccessful augmentation therapy.
Depression diagnosis must follow accepted clinical criteria (e.g. DSM-5) and be supported by a validated rating scale (e.g. PHQ-9, MADRS) at baseline and during follow-up.
- Administration & Safety Protocols
Spravato must be administered in a REMS-certified medical facility by a qualified provider.
Treatment must be combined with an oral antidepressant (not used as monotherapy).
Vital signs (e.g., blood pressure) must be monitored before and after each session.
Post-dose monitoring for sedation, dissociation, or other side effects for a specified observation period.
For continued therapy after the initial phase, documentation of symptom improvement based on depression rating scales (compared to baseline) may be required.
- Exclusion Criteria (What May Prevent Coverage)
Medicare will likely deny coverage if:
Spravato is prescribed without an oral antidepressant
Patient is under 18
Spravato is used outside FDA-approved dosing or indication
Administered outside a certified facility or without required monitoring
There are contraindications: e.g. severe hepatic impairment, history of certain vascular problems, uncontrolled medical conditions, or disqualifying psychiatric/substance-use history.
How to Check Your Medicare Spravato™ (Esketamine) Coverage
Because Medicare plans vary, coverage can differ. Here’s how to check:
- Confirm if Spravato is covered under your plan’s medical benefit.
- Call Medicare or your Medicare Advantage plan to verify Spravato coverage.
- Ensure your provider is REMS-certified to administer Spravato.
- Ask about any possible copays, deductibles, or coinsurance.
Libertas Mind can verify your benefits, handle prior authorization, and coordinate your treatment so you can begin care without delays.
How to Check Your Medicare Spravato™ Coverage
Because Medicare plan types vary (Original Medicare, Medicare Advantage, and supplemental plans), coverage can differ. Here’s how to check:
Confirm whether your plan uses the medical benefit for Spravato (as opposed to a pharmacy benefit).
Contact Medicare (or your Medicare Advantage plan) with your member ID and ask whether Spravato (esketamine nasal spray) is covered under your plan’s mental-health / medical-therapy benefits.
Ensure your treatment provider/clinic is REMS-certified and eligible under Medicare for Spravato administration.
Prepare and submit required documentation: prior antidepressant history, diagnosis, rating scale scores, and treatment plan.
Ask about potential out-of-pocket costs: copays, coinsurance, or deductibles may apply, depending on your plan.
Our team at Libertas Mind can handle benefit verification, prior authorization paperwork, and scheduling — helping you avoid delays or coverage issues.
Why Spravato™ (Esketamine) Matters Under Medicare
For many older adults or people covered under Medicare, depression that doesn’t respond to standard treatments can feel hopeless. Spravato offers:
A chance for meaningful improvement when other antidepressants have failed
Rapid onset of effects in some cases compared to traditional medications
Access under medical benefit, with safety oversight to protect vulnerable patients
Because of these benefits, it’s important that Medicare-eligible patients know about Spravato as a possible option — and know how to check coverage properly.
Libertas Mind Accepts Medicare Insurance
At Libertas Mind, we believe that quality mental health care should be accessible and easy to understand. We work with many Medicare and Medicare Advantage plans and help patients navigate what can often feel like a complex coverage process.
Our team can guide you through understanding your Medicare Spravato coverage, verifying eligibility, and beginning treatment at a certified Spravato center.
Libertas Mind Accepts Medicare Insurance
At Libertas Mind, we understand the complexities of Medicare coverage. We accept many Medicare and Medicare Advantage plans, and support patients through every step:
Benefit verification
Prior authorization submissions
Clinic scheduling and treatment
Cost estimations and patient support
We aim to make Spravato treatment as accessible and transparent as possible for Medicare recipients.
Contact us today to check your plan and begin your treatment journey.
FAQs About Medicare and Spravato™ (Esketamine) Coverage
Medicare may cover Spravato, depending on your diagnosis and your specific Medicare plan type. Original Medicare and many Medicare Advantage plans cover Spravato when medical-necessity criteria are met and treatment is administered in a certified facility.
You must be 18 or older, have treatment-resistant depression or MDD with suicidal ideation, show inadequate response to previous antidepressants, and receive Spravato in a REMS-certified setting with required monitoring.
Original Medicare may not require formal prior authorization, but Medicare Advantage plans almost always do. In both cases, documentation of diagnosis, treatment history, and safety measures is required.
Yes. Our care team can check your Medicare benefits, determine whether prior authorization is needed, handle all documentation, and schedule your treatment at a certified facility.
