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Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
Getting the first Spravato authorization is one hurdle. Keeping coverage through continuation and maintenance is a separate one, and it is decided on different evidence. This guide explains how re-authorization works, what plans look for, and what to track from the first session so renewal is straightforward.
The labeled schedule is twice weekly for weeks 1 through 4, then weekly for weeks 5 through 8, then weekly or every two weeks in maintenance based on response. Insurers generally authorize against these phases rather than approving an unlimited course, so a renewal request usually lands at each transition. Our REMS and monitoring guide covers what each visit involves.
The deciding factor is measured change. A chart showing a PHQ-9 falling from 21 to 10 across induction makes the case on its own; “patient reports feeling better” does not carry the same weight. If your plan’s policy requires a concurrent oral antidepressant, reviewers look for evidence it is continuing. Note that since January 2025 the FDA has approved Spravato as a standalone monotherapy for treatment-resistant depression, so this is a plan-policy question rather than a label requirement. Reviewers also look for consistent attendance at monitored sessions.
We build this record as treatment proceeds rather than reconstructing it at renewal time, which is the single biggest reason renewals go smoothly. The same logic applies to TMS re-treatment; see TMS maintenance and re-treatment coverage.
A continuation denial is appealable like any other, and the fix is usually supplying the response documentation the reviewer did not see. See how to appeal a Spravato denial in California.
Most plans authorize in phases that mirror the label: an induction period, then continuation. Re-authorization is typically requested when moving from twice-weekly induction to the weekly and every-two-week maintenance phases, and periodically thereafter.
Evidence of response. That means documented symptom scores showing improvement, attendance at monitored sessions, a clinical rationale for continuing, and a concurrent oral antidepressant if the plan’s own policy still requires one.
There is no fixed endpoint in the label, but plans review continuation periodically rather than approving treatment open-endedly. Ongoing coverage depends on documented benefit and continued medical necessity.
Gaps can complicate re-authorization because plans look for consistent participation. If life events interrupt treatment, tell your clinic so the reason is documented rather than appearing as unexplained non-adherence.
This article is educational and is not personal medical or billing advice. Plan rules vary and change over time. If you are in crisis, call or text 988.
