Does Medicare Cover Spravato (Esketamine) Treatment?

Does Medicare Cover Spravato (Esketamine) Treatments?

Yes, Medicare will cover Spravato treatments if your doctor has recommended it. Medicare Part B coverage is crucial for beneficiaries who require Medicare Spravato coverage because of the medication’s high cost.¹

MEDICARE INSURANCE ELIGIBILITY

• United States citizen
• 65 or older
• Or younger, if you have a disability or End Stage Renal Disease

Jump to Section

• Does Medicare Cover Spravato (Esketamine) Treatments?
• How to Verify Medicare Coverage for Spravato
• What is Spravato?
• How Much Does Spravato Cost Without Insurance?

How to Verify Medicare Coverage for Spravato

Athena Care and its multiple Spravato treatment clinics in Tennessee are in-network with most major insurance plans. Contact us below and a care coordinator will help you navigate your insurance coverage. Allow our highly skilled care coordinators to handle the challenges of contacting your insurance company for more information about Medicare esketamine nasal spray coverage.

What is Spravato?

Spravato, or Esketamine, is a nasal spray used to treat treatment resistant depression (TRD). Approved by the Food and Drug Administration (FDA) in March of 2019, Spravato is used in conjunction with an oral antidepressant to treat individuals with TRD and adults with major depressive disorder (MDD).² TRD encompasses patients with MDD with acute suicidal ideation or behaviors. These individuals have not responded to psychotherapy and at least two antidepressant drugs administered at acceptable doses for an adequate time.³

Although the impact rate varies, randomized trials have demonstrated that Spravato can effectively treat TRD. Depending on the length of Spravato treatment, studies suggest 40-60% efficacy.⁴

The efficacy of Spravato was evaluated in three four-week clinical trials and one longer-term maintenance-of-effect experiment. In the three short-term studies, patients were randomized to receive Spravato or a placebo nasal spray. All of the patients started a new oral antidepressant at the same time. They continued it throughout the trials due to the seriousness of TRD.

Spravato had a statistically significant effect on the severity of depression in one of the short-term studies, and some of those effects were apparent within two days. However, the two other short-term trials did not pass the statistical tests necessary to demonstrate efficacy. In the longer-term maintenance-of-effect trial, individuals in stable remission who continued to take Spravato combined with an oral antidepressant experienced significantly fewer relapses of depressive symptoms than those on placebo nasal spray.

Risks & Side Effects of Spravato

The following are the most common side effects patients who have undergone Spravato treatment have experienced:

• Disassociation
• Dizziness
• Nausea
• Drowsiness
• Vertigo
• Decreased feeling or sensitivity (hypoesthesia)
• Anxiety
• Lethargy
• Elevated blood pressure
• Vomiting
• Feeling inebriated

Esketamine packaging warns about potential abuse, misuse, and the risk of sleepiness and dissociation. Additionally, there is a chance that suicidal thoughts and actions will be more prevalent in children and young people.⁵ For this reason, Spravato is not approved for use in children. Additionally, patients with aneurysmal vascular disorders or uncontrolled hypertension may be more vulnerable to complications.

Furthermore, Spravato may impair one’s motor, thinking, judgment, and response time skills.

After taking the medication, you shouldn’t drive or use machinery until the following day. Women who are pregnant or intend to become pregnant should take precautions because Spravato also has the potential to harm a fetus. While receiving treatment, women shouldn’t breastfeed.

These side effects could persist anywhere from a few days to several weeks. If the side effects persist, worry you, or become severe, talk to your Spravato doctor.⁶ Keep in mind that the oral antidepressant could be what is causing side effects instead of Spravato.

Spravato treatments are only available in licensed healthcare settings, with trained medical personnel authorized to prescribe and dispense the medication.⁷ Therefore, Spravato is not available at your local pharmacy.

The Food and Drug Administration (FDA) launched the Risk Evaluation and Mitigation Strategy (REMS) program⁸ to lower the dangers of giving certain medications with severe adverse effects. REMS programs also assist customers in medication management, and they instruct healthcare providers on how to closely monitor and prescribe these medications.⁹ This allows a Spravato clinician to determine whether the drug is safe and effective.

Average Cost of Spravato Treatment With Medicare Insurance

The financial aspect of mental health treatment can often be a deciding factor for many individuals. In the context of the average cost of Spravato with Medicare insurance, it’s important to consider several factors. Depending on whether you’re receiving Spravato doses weekly or bi-weekly, costs can range from $5,664 to $8,142 in the first month of treatment. Regular doctor’s visits, which are usually around $150, should also be factored into your budgeting for Spravato.

Out-of-pocket expenses can be reduced with Medicare insurance, making the cost of esketamine therapy more manageable. Financial assistance for Spravato is also available, potentially reducing the cost to as low as $10 per treatment for eligible and commercially insured patients. When managing Spravato expenses, consultation with your provider and insurance company for accurate pricing information for Spravato is crucial. Remember, investing in mental health is a worthy expense, and there are resources available to make this investment more feasible.

How Much Does Spravato Cost Without Insurance?

Without Medicare Spravato coverage, the following are average costs for the treatment. These costs will differ by location and other variables. Therefore, they may not reflect the actual cost of what you’ll pay for this treatment in Tennessee.

You’ll most likely pay more at the beginning of treatment and less in the long run. Depending on whether you’re receiving Spravato doses weekly or bi-weekly, costs can range from $5,664 to $8,142 in the first month of treatment, $2,832 to $4,248 in the second month, and possibly $1,416 to $4,248 each following month.

Spravato Treatment Center Near Me That Accept Medicare

If you’re searching for “Spravato treatments near me” or “Esketamine treatment near me,” and you’re a Medicare insurance holder, Athena Care is here for you. As a leading provider of mental health services, we have multiple locations across Tennessee and may accept Medicare insurance. Our aim is to make innovative treatments like Spravato (Esketamine) accessible and financially manageable for all our patients.

We have a strong footprint in Tennessee with treatment centers in major cities such as Nashville and Memphis, and also in Franklin, Murfreesboro, Hendersonville, Clarksville, and Knoxville. These local centers ensure that wherever you are in the state, quality mental health care is never too far away.

To find the nearest Athena Care center offering Spravato treatments, we recommend reaching out to us directly or using resources such as the SPRAVATO® treatment center locator or the Medicare Health Care Provider Directory. Each step towards seeking help is a step towards wellness and recovery. Your mental health matters, and finding the right treatment in your area is a crucial part of this journey.