Spravato™️, Johnson & Johnson’s nasal esketamine spray, is covered by most major insurance companies, including Medicare, when the patient meets the required criteria.

Unlike generic ketamine, the FDA approved Spravato™️ for use in patients with treatment resistant depression and major depressive disorder with suicidal ideations.

InsInsurance plans require that you meet several criteria for a Spravato™️ treatment to be eligible for coverage including:

• Having a diagnosis of major depressive disorder
• Having tried at least 2 antidepressants without success
• Not having any of the contraindicated medical conditions for safe use of Spravato™️

Plans’ coverage criteria must meet the minimum FDA requirements, though they reserve the right to include additional requirements. This includes requiring prior authorization from the plan before receiving services. Prior authorizations can take 2+ weeks to be processed by the plan, so unfortunately patience is often required!

How much the plan covers depends on your plan, the benefit structure, and whether your provider is in-network with your insurance plan. Some insurance plans treat Spravato™️ as a medical drug, which is covered under your medical benefit while others consider it a specialty drug, which is covered through your pharmacy benefit.

How your plan treats Spravato™️ coverage will determine your share of cost for the treatments, along with other factors such as your plan design and whether you’ve met your deductible or out-of-pocket maximum.

If you want to get an estimate for how much your plan will cover, you can try checking some of the codes that are typically billed for these treatments. The specific codes that are ultimately used will depend on how you provider bills but this can be a helpful start.

Commonly used Spravato codes:

• G2082 or G2082
• S0013

For more information on specifics on how Spravato communicates about insurance coverage, coding, and reimbursement, you can review the material they’ve provided.