Cost Guides
How Much Does Spravato (Esketamine) Cost in 2026?
By the TMS Nearby editorial team · Reviewed June 12, 2026
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. Unlike generic ketamine, it's covered by most major insurers.
Because Spravato carries a REMS safety requirement, every dose is administered at a certified clinic with two hours of monitoring — so the price includes both the drug and the clinical visit.
Typical Spravato costs
| Scenario | Typical cost |
|---|---|
| Per session, with commercial insurance | $10 – $300 copay |
| Per session, cash pay (drug + administration) | $400 – $900 |
| Induction month (8 sessions), cash pay | $3,200 – $7,200 |
| First year, cash pay (induction + maintenance) | $10,000 – $25,000 |
| With Janssen savings program (eligible commercial plans) | As little as $10 per treatment |
Why the dosing schedule matters for cost
Spravato starts intensive and tapers: twice weekly for the first four weeks, weekly for weeks five through nine, then every one to two weeks for maintenance. Your first month is the most expensive; ongoing maintenance is roughly two to four sessions per month at most.
Insurance coverage and prior authorization
Most commercial insurers, Medicare, and many Medicaid programs cover Spravato for treatment-resistant depression. Prior authorization is standard: insurers generally require documented trials of at least two antidepressants without adequate response.
Coverage usually requires treatment at a REMS-certified clinic, and your insurer may require the clinic to be in network. The drug itself is sometimes billed through your medical benefit and sometimes through your pharmacy benefit — which affects your out-of-pocket cost, so ask the clinic which pathway your plan uses.
The Janssen Spravato savings program
Janssen's Spravato withMe program reduces costs to as little as $10 per treatment for eligible patients with commercial insurance, subject to annual program maximums. Patients with Medicare, Medicaid, or other government insurance aren't eligible for the copay card, but the program also offers benefit-investigation help for everyone.
Frequently asked questions
Is Spravato covered by Medicare?
Yes. Medicare covers Spravato for treatment-resistant depression when administered at a REMS-certified site and clinical criteria are met. Note that government-insured patients aren't eligible for Janssen's copay savings card.
Why is Spravato more expensive than ketamine per dose?
The list price of the branded drug is high, and every visit includes two hours of required clinical monitoring. But because insurance usually covers Spravato and rarely covers ketamine, the insured patient's out-of-pocket cost for Spravato is typically far lower.
How long do I have to keep taking Spravato?
There's no fixed endpoint — patients who respond usually continue maintenance dosing every one to two weeks, with frequency adjusted by their psychiatrist based on symptoms.
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Sources
This guide is for educational purposes only and is not medical, legal, or insurance advice. Costs, coverage, and clinical suitability vary by individual, plan, and clinic — always verify directly with your provider and insurer. If you're in crisis, see our crisis resources.