Which insurers cover SPRAVATO®? What major health plans ask for

Short answer: many large health plans, including UnitedHealthcare, Aetna, and Cigna, publish written coverage policies for SPRAVATO® (esketamine) nasal spray. Coverage is usually possible, but almost always requires prior authorization, and your own plan documents decide what is covered. This page summarises public policies; it is not a coverage guarantee or medical advice.

What published payer policies have in common

We reviewed publicly posted policies from UnitedHealthcare, Aetna, and Cigna (2026 versions). Details differ, but they commonly look for:

• An FDA-approved use. Policies generally limit coverage to the two adult indications on the label: treatment-resistant depression, and depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior (with an oral antidepressant). Other uses are typically treated as not medically necessary.
• Adults only. Patients must be 18 or older.
• Proof of prior treatment. For treatment-resistant depression, plans want records showing a lack of meaningful improvement after at least two different antidepressants at adequate doses and durations in the current episode. Some plans define an adequate trial more specifically (for example, a set number of weeks).
• A REMS-certified setting. The prescriber or treatment center must be certified in the SPRAVATO® REMS, and the dose must be given under direct supervision with at least two hours of monitoring.
• Depression rating scores. Plans often ask for a standardised score (such as PHQ-9, MADRS, HAM-D, or BDI) before starting, and again to show response when renewing.
• Specialist involvement. Some plans require a psychiatrist to prescribe or be consulted.
• Time-limited approvals. Authorizations are usually renewed only with documented benefit.
• Substance-use screening. At least one plan excludes members with an untreated moderate or severe substance or alcohol use disorder.

Medical benefit or pharmacy benefit?

Because SPRAVATO® is given in a clinic, it is often billed under the medical benefit (the center buys the medicine and bills the plan). Some plans, including Medicare Advantage and Medicaid plans, may route it through the pharmacy benefit instead. This affects which authorization form is used and what you pay, so ask your plan which applies.

Blue Cross Blue Shield, Medicare, and Medicaid

• Blue Cross Blue Shield is not one insurer. It is a group of independent companies, and each sets its own policy. Look up the policy for the specific Blue plan on your card.
• Medicare: coverage depends on whether you have Original Medicare or a Medicare Advantage plan. Ask the treatment center how they bill Medicare for SPRAVATO® visits.
• Medicaid: coverage and criteria vary by state and by managed-care plan.

How to check your own coverage

1. Call the member services number on your card and ask whether SPRAVATO® is covered under the medical or pharmacy benefit.
2. Ask for the plan's written coverage policy or prior-authorization criteria.
3. Confirm the treatment center is in network and REMS-certified.
4. Ask the center to estimate your costs for the medicine, the visit, and monitoring.
5. If you are denied, ask for the reason in writing and the appeal steps.

Sources

• UnitedHealthcare, Ketalar® (Ketamine) and Spravato® (Esketamine) Commercial Medical Benefit Drug Policy, effective May 1, 2026, and Spravato Prior Authorization/Medical Necessity program, effective July 1, 2026 (uhcprovider.com).
• Aetna, Esketamine (Spravato) Medical Clinical Policy Bulletin 0950 (aetna.com).
• Cigna, Psychiatry – Spravato Drug Coverage Policy IP0220 (static.cigna.com).
• FDA, SPRAVATO® Prescribing Information, revised January 2025.

Policies change often. Always confirm current criteria with your plan. Editorial summary by the Esketamine Therapy editorial team; not medical advice. In an emergency, call 911 or call or text 988.