Spravato Medicare Coverage: What You Need to Know

What is Spravato?

Spravato, also known as Esketamine, is an FDA-approved prescription medication for the treatment of adults with treatment-resistant depression (TRD). In other words, it’s for people who’ve tried at least two other antidepressants and they didn’t work (you know when you’re trying to fit a square peg into a round hole?). Instead of pills, Spravato is a nasal spray, and you have to take it in a certified medical facility under supervision (so no taking this on the go while you’re running errands).

Unlike traditional antidepressants, Spravato works faster, but you still need to take an oral antidepressant to keep depression at bay. Think of it as the fast-moving hare teamed up with the steady, reliable tortoise.

Does Medicare Cover Spravato?

The big question: Does Medicare cover Spravato? Yes, but it’s not that simple. If you’re covered under Medicare Part B, which covers outpatient services, Spravato treatment is likely covered because it has to be administered in a certified medical facility. The catch here is that Medicare Part B covers the cost of administration, but you’ll want to verify Medicare coverage for your specific plan to make sure you’re not left holding the bag.

If you’re on a Medicare Advantage plan (Part C), coverage rules can be a little different. Many Medicare Advantage Plans do cover Esketamine, but the devil’s in the details, so you’ll want to check with your specific plan to see how they handle prescription drugs like Spravato.

Verify Coverage

Before you head to your treatment center, let’s talk about verifying that Medicare will cover your Spravato treatment. You don’t want any surprises, do you? Here’s how:

• 1-800-MEDICARE or visit the Medicare website to verify coverage.

• Get your doctor involved. They’ve done this before and can guide you through the process.

• If you’re on Medicare Advantage, contact your plan provider for prescription drug coverage details.

Henry Beltran, owner of Medicare Advisors Insurance Group LLC, says, “Verifying coverage is one of those things you don’t want to leave until the last minute. Trust me, nobody wants surprise bills in their mailbox.”

Side Effects and Risks of Spravato

Let’s face it—side effects come with the territory, and Spravato is no exception. Here are some of the most common side effects:

• Sleepiness (you might want to schedule a nap afterward)

• Dissociation (a.k.a. feeling like you’re floating outside your body, which sounds fun until it isn’t)

• Suicidal thoughts (this is serious, and you need to talk to your doctor about it)

• Impaired motor skills (so no driving or operating heavy machinery after treatment unless you want to star in a sitcom called “Oops, I Crashed My Tractor.”)

If you have uncontrolled hypertension or aneurysmal vascular disorders, Spravato may not be an option, so you’ll want to get a full health review from your healthcare provider. Oh, and if you’re pregnant or planning to be, Spravato may not be the right fit for you either—talk to your doctor.

Cost of Spravato Treatment with Medicare

Now let’s get to the point: How much does Spravato cost? The average cost of Spravato treatment with Medicare insurance is $5,664 to $8,142 in the first month. That’s a big range, right? Don’t forget about your regular doctor’s visits, which are $150 each. Not exactly chump change, but there are financial assistance options available.

If you qualify for certain cost support programs like the SPRAVATO withMe program, the cost can be as low as $10 per treatment—talk about a discount! Eligibility criteria apply, so you’ll want to check if you qualify for financial assistance.

Where to Get Spravato Treatment

Finding a certified medical facility that offers Spravato treatment isn’t as hard as finding Waldo, but it can still take some work. Here’s where to start:

• Ask your doctor for recommendations.

• Check with your Medicare Advantage Plan provider for a list of in-network treatment centers.

Since Spravato has to be taken in a certified medical facility, you’ll want to make sure the place you choose is properly certified. No home delivery on this one, folks!

Patient Support: SPRAVATO withMe

And speaking of financial assistance, let’s talk about the SPRAVATO withMe program. This patient support program offers everything from cost support to helping you understand your insurance coverage. They even give you a Care Navigator—someone who can guide you through the process and make it as smooth as possible.

Henry Beltran says, “If you’re struggling to understand your coverage or juggle costs, programs like SPRAVATO withMe are a great resource. It’s like having an expert on your side when things get confusing.”

Get Started with Spravato Treatment

You ready to try Spravato? Here’s what to do:

• Talk to your doctor about Spravato.

• Check your Medicare coverage so you don’t get any surprise bills.

• Find a certified treatment center to get the nasal spray.

• Enroll in SPRAVATO withMe for cost support and patient support.

Spravato Side Effects (with a little humor)

While Spravato is considered a game-changer for major depressive disorder, it’s not without its drawbacks. Here are the risks explained with a wink:

• Dissociation: Feel like you’ve left reality? Yep, that’s Spravato. Not ideal for your Monday morning meeting.

• Sleepiness: If you like daytime naps, you’re in luck. Otherwise, your afternoon productivity will take a hit.

• Impaired motor skills: Trying to take Spravato and then drive? You might want to rethink that… unless you’re auditioning for the next Fast & Furious movie.

Medicare for Spravato

When it comes to Medicare coverage for Spravato, remember it’s generally under Medicare Part B, since it’s an outpatient service. But you’ll still want to check your Medicare Advantage or prescription drug coverage.

Many plans will cover Spravato, but as Henry Beltran says, “With Medicare, always read the fine print. It’s worth it to know what you’re getting into.”

Costs and Medicare Savings Program

The cost of Spravato treatment seems high, but there’s a way to reduce it:

• See if you qualify for Medicare Savings Programs.

• Look into the low-income subsidy option to help offset costs.

• Check out financial assistance options from Janssen Pharmaceuticals or the Johnson Patient Assistance Foundation.

While Spravato is expensive, these cost support options can help you manage out-of-pocket costs.

Bottom Line

In the end, it all comes down to understanding Spravato Medicare coverage if you have treatment-resistant depression. Verifying your Medicare Part B or Medicare Advantage Plan coverage and finding a certified treatment center is a lot to navigate, but it can be done with the right support.

And don’t forget SPRAVATO with Me, which has some big help with insurance and cost support. As Henry Beltran says, “With the right plan in place and your provider’s support, Spravato can make a big impact on your mental health treatment journey.”

Just don’t forget to schedule a nap—Spravato makes you sleepy!