Is Spravato covered by your insurance?
For most people, yes — if you meet your plan’s requirements and get prior authorization. Here’s how coverage works in Arizona, and how Same Team can help you find a clinic that takes your plan.
This guide explains Spravato coverage for Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, Tricare, AHCCCS, and Medicare.
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What insurers usually require
Spravato (esketamine) nasal spray is FDA-approved for adults with treatment-resistant depression. Because it’s given in a certified clinic, plans almost always require prior authorization.
- A diagnosis of treatment-resistant depression, or major depressive disorder with acute suicidal thoughts or behavior
- Documentation that at least two antidepressants have not worked well enough during the current episode
- Treatment at a clinic certified in the Spravato REMS program, where you are monitored for at least two hours after each dose
- Age 18 or older
- Prior authorization submitted by the clinic before treatment starts
Spravato coverage by insurer
General guidance only — coverage varies by plan and can change. Always confirm with your plan or clinic.
Does Blue Cross Blue Shield cover Spravato?
Commercial Blue Cross plans generally cover Spravato for eligible patients, usually under the medical benefit, with prior authorization. Your costs depend on your plan’s deductible, copay, or coinsurance.
Blue Cross Blue Shield Spravato guideDoes Aetna cover Spravato?
Aetna commercial plans generally cover Spravato for eligible patients with prior authorization. The clinic submits your treatment history; costs depend on your specific plan.
Aetna Spravato guideDoes UnitedHealthcare cover Spravato?
UnitedHealthcare commercial plans generally cover Spravato for eligible patients with prior authorization, typically under the medical benefit since it is given in the clinic.
UnitedHealthcare Spravato guideDoes Cigna cover Spravato?
Cigna commercial plans generally cover Spravato for eligible patients with prior authorization. Choosing an in-network clinic usually keeps out-of-pocket costs lower.
Does Tricare cover Spravato?
Tricare covers Spravato for eligible adults with prior authorization. In Arizona (the West Region), requests go through TriWest. Manufacturer copay programs can’t be used with Tricare.
Tricare Spravato guideDoes AHCCCS (Arizona Medicaid) cover Spravato?
AHCCCS health plans require prior authorization for Spravato, and the exact criteria vary by plan. Initial approvals are often time-limited and need reauthorization based on progress.
AHCCCS Spravato guideDoes Medicare cover Spravato?
Medicare Part B generally covers Spravato given in a certified clinic. Under Original Medicare you typically pay 20% coinsurance after the Part B deductible; a Medigap plan may help. Medicare Advantage rules vary by plan.
Medicare Spravato guideOur navigation call is free for everyone, including people with Medicare, AHCCCS, or Tricare. Same Team’s separate coaching services are not covered by Medicare, Medicaid/AHCCCS, or Tricare — see the plans we accept.
Sources: FDA Spravato prescribing information (2025); Janssen, Spravato payer coverage & Prior Authorization Toolkit (spravatohcp.com); Humana Military / TriWest Spravato request requirements; Arizona Complete Health (AHCCCS) esketamine pharmacy policy; Medicare.org, “Does Medicare cover esketamine?” (2025).
Arizona guides
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Spravato coverage by insurer
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Spravato insurance questions
Is Spravato covered by insurance?
Most major commercial plans and Medicare Part B cover Spravato for eligible patients, almost always with prior authorization. Medicaid (AHCCCS in Arizona) and Tricare also cover it for eligible patients with prior authorization. Exact rules depend on your plan.
What does prior authorization for Spravato usually require?
Insurers typically require a diagnosis of treatment-resistant depression or depression with acute suicidal thoughts, records showing at least two antidepressants did not work well enough, and treatment at a REMS-certified clinic. The clinic submits this paperwork for you.
How much does Spravato cost with insurance?
It depends on your plan. Costs can include the medication, the clinic visit, and the required two-hour monitoring, minus what your plan pays. Commercially insured patients may be eligible for the manufacturer’s Spravato withMe savings program; it cannot be used with Medicare, Medicaid/AHCCCS, or Tricare.
Can Same Team help if I have Medicare, AHCCCS, or Tricare?
Yes. Our navigation call is free and open to everyone. Please note that Same Team’s separate coaching services are not covered by Medicare, Medicaid/AHCCCS, or Tricare.
What happens if my Spravato request is denied?
Your clinic can usually appeal, often with a letter of medical necessity and additional records. A Same Team navigator can help you understand your options and next steps.
Not sure where to start?
Schedule a navigation call and a Same Team navigator will help you understand your options and find care that fits.
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