Q&A About Spravato and Insurance Coverage
Many insurers do cover Spravato, including Cigna, Aetna, Blue Cross Blue Shield, United Healthcare, Medicaid, and Medicare. However, coverage varies by plan and state.
With insurance, costs can vary. Medicare Part B, for example, pays 80% of expenses, including the medication and the doctor’s visit.
Yes, the Spravato WithMe initiative allows eligible patients to pay only $10 per treatment, with a maximum benefit of over $8k per calendar year.
Requirements often include a diagnosis of treatment-resistant depression or major depressive disorder with acute suicidal ideation, and previous unsuccessful trials of other antidepressants.
Billing involves codes for both drug delivery and supervision, as treatment requires administration and a monitoring period of at least 2 hours.
Yes, insurance coverage typically includes both the cost of the Spravato nasal spray and the associated monitoring session.
Contact your insurance provider directly or work with your healthcare provider to check your coverage and any preauthorization requirements.
If insurance doesn’t cover Spravato, discuss alternative options with your healthcare provider. Some patients may be eligible for patient assistance programs or clinical trials.
No, Spravato can only be administered in certified healthcare settings under medical supervision due to its Risk Evaluation and Mitigation Strategy (REMS) program requirements.
Remember, insurance coverage for Spravato can be complex and varies widely. It’s best to work closely with your healthcare provider and insurance company to understand your specific coverage and options.
