Medicaid and Spravato™ (Esketamine) – Is It Covered?
Does Medicaid cover Spravato™ (Esketamine)?
In many states, Medicaid does cover Spravato when very specific medical criteria are met, and treatment is given in a certified clinic. Coverage is not automatic and depends on your state’s Medicaid program, your diagnosis, and whether you meet strict medical-necessity rules.
At Libertas Mind, we regularly work with Medicaid plans and help patients navigate prior authorization so they can access Spravato safely and with the lowest possible out-of-pocket cost.
Medicaid programs typically require a detailed review of your mental health history, your response to past treatments, and confirmation that Spravato will be given in a REMS-certified healthcare setting.
Medicaid Spravato™ (Esketamine) Coverage Requirements
While each state sets its own rules, most Medicaid policies for Spravato include similar criteria. In general, patients must:
- You must be:
- 18 years of age or older
- You must have one of the following:
- Treatment-resistant depression (TRD) – depression that has not improved despite trying multiple antidepressants
- Major depressive disorder (MDD) with acute suicidal ideation or behavior
- You must also meet ALL of the following:
- Depression diagnosed and tracked using a validated rating scale such as PHQ-9, HAM-D, MADRS, or similar tools
- Prior inadequate response to at least two antidepressants from different classes (for example, an SSRI and an SNRI, or a TCA and bupropion), usually for at least 4 weeks each at therapeutic doses
- In many states, failure of at least one antidepressant “augmentation” strategy (such as adding an atypical antipsychotic, lithium, or thyroid hormone) before moving to Spravato
- Spravato is prescribed by, or in consultation with, a psychiatrist or qualified behavioral-health specialist
- Treatment is administered only in a REMS-certified clinic, with direct supervision and monitoring for at least two hours after each dose
- Blood pressure and vital signs were checked before and after treatment
- Ongoing documentation that Spravato is improving symptoms compared with your baseline depression rating (often re-verified every 3–6 months for renewal of coverage)
- No disqualifying medical or psychiatric conditions, such as certain uncontrolled cardiovascular diseases or recent moderate-to-severe substance-use disorders, depending on state policy
These requirements help Medicaid decide when Spravato is medically necessary and ensure it is used in the safest way possible.
How to Check Medicaid Spravato™ (Esketamine) Coverage
Because Medicaid is state-run, coverage rules and paperwork can look different from one state to another. In general, here’s how to check your Spravato coverage:
- Call the number on your Medicaid card or log in to your state’s Medicaid member portal and ask if Spravato (esketamine nasal spray) is covered for depression.
- Ask whether Spravato is billed under the medical benefit, pharmacy benefit, or both, and if prior authorization is required. (it almost always is)
- Confirm that your treating provider and clinic are enrolled with Medicaid and certified to administer Spravato under the REMS safety program.
- Gather your treatment history (medications you’ve tried, doses, and duration), so your prescriber can submit a strong prior authorization request.
- Ask about any copays or nominal fees your state may charge for specialty medications.
At Libertas Mind, our care coordinators can handle most of this for you, verifying benefits, helping with paperwork, and communicating with Medicaid so you don’t have to manage it alone.
How to Check Medicaid Spravato™ Coverage
Because Medicaid is state-run, coverage rules and paperwork can look different from one state to another. In general, here’s how to check your Spravato coverage:
- Call the number on your Medicaid card or log in to your state’s Medicaid member portal and ask if Spravato (esketamine nasal spray) is covered for depression.
- Ask whether Spravato is billed under the medical benefit, pharmacy benefit, or both, and if prior authorization is required. (it almost always is)
- Confirm that your treating provider and clinic are enrolled with Medicaid and certified to administer Spravato under the REMS safety program.
- Gather your treatment history (medications you’ve tried, doses, and duration), so your prescriber can submit a strong prior authorization request.
- Ask about any copays or nominal fees your state may charge for specialty medications.
At Libertas Mind, our care coordinators can handle most of this for you—verifying benefits, helping with paperwork, and communicating with Medicaid so you don’t have to manage it alone.
Why Spravato™ (Esketamine) Matters for Medicaid Patients
For many people on Medicaid living with severe or treatment-resistant depression, options can feel limited. Spravato offers:
- A different mechanism of action than traditional antidepressants
- The possibility of faster symptom relief in some patients who have not improved on standard medications
Because it must be given in a monitored setting and is closely regulated, Medicaid requires strong justification before approval, but when those criteria are met, many state programs do help cover Spravato treatment.
Libertas Mind and Medicaid
At Libertas Mind, we believe that effective mental health care should be accessible to everyone. We work with many Medicaid plans and help patients navigate what can often feel like a complicated system.
Our team can guide you through understanding your Medicaid Spravato coverage, verifying eligibility, and starting treatment at a certified Spravato center.
Libertas Mind and Medicaid
At Libertas Mind, we believe that effective mental health care should be accessible to everyone. We work with many Medicaid plans and help patients navigate what can often feel like a complicated system.
Our team can guide you through understanding your Medicaid Spravato coverage, verifying eligibility, and starting treatment at a certified Spravato center.
Contact us today to begin your Spravato treatment journey.
FAQs About Medicaid and Spravato™ (Esketamine) Coverage
Many state Medicaid programs do cover Spravato, but approval depends on strict medical criteria, your diagnosis, and detailed prior authorization. Coverage varies by state.
You must be 18 or older, have treatment-resistant depression or MDD with acute suicidal ideation, and show documented failure of previous antidepressants often including attempts at augmentation therapy. Treatment must also be administered in a REMS-certified facility.
Yes. Medicaid requires extensive documentation, including diagnosis, depression rating scores, prior medication history, and a clear treatment plan before approving Spravato.
Most Medicaid plans have little to no cost for Spravato treatment, though some states may require a small copay. Libertas Mind can verify your specific cost details.
No. Spravato cannot be dispensed through retail pharmacies. It must be administered in a certified clinic with two-hour post-dose monitoring as required by federal safety guidelines.
Absolutely. Our care team can verify your Medicaid coverage, gather required documentation, handle the prior authorization process, and schedule your treatment at a certified facility.
