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Yes, in most cases. Aetna generally covers Spravato for treatment-resistant depression once prior authorization is approved. We are in network with Aetna, so we bill them directly and handle the authorization for you.
What this page answers
Plans differ, but the checklist is almost always the same:
Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
Once approved, you pay your normal specialist or outpatient cost share. That is usually a copay per session, or coinsurance until you hit your deductible.
There is also a manufacturer savings program. If you have commercial insurance, it can bring your cost down to as little as $10 per treatment. It cannot be used with Medicare or Medi-Cal.
See Spravato costs in California for the full picture.
You never get a surprise. We confirm the number before anything begins.
In the trial behind FDA approval, adults who added esketamine to a newly started antidepressant improved more than those on the antidepressant alone (Popova 2019). A follow-up study found continuing Spravato after improvement cut relapse risk by about half (Daly 2019). Response varies and is not guaranteed.
Generally yes, for treatment-resistant depression with prior authorization. Plans differ, so we verify yours.
Yes, and we bill Aetna directly.
Usually one to two weeks after we submit.
Most denials come down to missing documentation of earlier antidepressant trials. We can appeal with a fuller history.
If TMS is also on your mind, see whether Aetna covers TMS and whether you qualify for Spravato.
Educational only, not medical advice. Coverage rules change and vary by plan. Confirm your specific benefits with your insurer and a qualified clinician. Results vary and no outcome is guaranteed.
Medically reviewed by Nefretiri Abat, J.D., PMHNP-BC, board-certified Psychiatric-Mental Health Nurse Practitioner.
Yes. We are in network with Aetna and bill them directly.
Usually one to two weeks once the documentation is submitted. We handle the paperwork.
Denials are often about missing documentation of past antidepressant trials. We can appeal with a fuller history.
Across commercial plans the core requirement is consistent: an adult with major depressive disorder who has had an inadequate response to at least two oral antidepressants, each taken at an adequate dose for an adequate duration. Plans increasingly specify that those two trials come from different drug classes. Most also expect the prescription to come from, or in consultation with, a psychiatric prescriber, and many ask for a baseline depression rating scale such as the PHQ-9 or MADRS.
One point worth raising with Aetna directly: the FDA approved Spravato as a standalone monotherapy for treatment-resistant depression in January 2025. Some plan policies still require a concurrent oral antidepressant and others have begun removing that condition. If your plan still requires it, that is a policy position rather than a label requirement, and it is worth naming in an appeal.
Coverage generally follows the labeled schedule: twice weekly during weeks 1 through 4, weekly during weeks 5 through 8, then weekly or every two weeks in maintenance. Insurers typically authorize against those phases rather than approving an open-ended course, so a renewal request usually lands at each transition and turns on documented response. Our guide to Spravato re-authorization covers what those reviews weigh.
Because Spravato must be given in a REMS-certified setting with at least two hours of monitoring, the treatment setting and prescriber must be enrolled before the first dose. See REMS and monitoring requirements.
See our Spravato documentation checklist and, if a request is turned down, how to appeal in California.
Generally an inadequate response to at least two oral antidepressants taken at an adequate dose and duration, with plans increasingly specifying two different drug classes. Aetna also expects the prescription to come from or in consultation with a psychiatric prescriber.
Not under the FDA label since January 2025, when Spravato was approved as a standalone monotherapy for treatment-resistant depression. Some insurance policies still require a concurrent oral antidepressant, so it is worth confirming your plan’s current position before submitting.
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