Does Blue Shield of California Cover Spravato?

Yes, in most cases. Blue Shield of California generally covers Spravato for treatment-resistant depression once prior authorization is approved. Because Spravato is given in the office, it is usually handled as a medical benefit instead of a pharmacy one. We are in network and submit the request for you.

What Blue Shield usually asks for

Plans differ, but the checklist is almost always the same:

• A diagnosis of treatment-resistant depression
• Documented trials of at least two antidepressants that did not work well enough
• Prior authorization before your first session
• Treatment at a REMS-certified site, which we are
• An oral antidepressant taken alongside Spravato

What you will actually pay

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.

How to get started

1. Book a consultation. We review your full medication history.
2. If Spravato fits, we verify your Blue Shield benefits and submit the prior authorization.
3. We tell you your expected out-of-pocket cost before your first session.
4. Sessions start once approval comes through, usually within one to two weeks.

You never get a surprise. We confirm the number before anything begins.

Does it work?

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.

Common questions

Does Blue Shield cover Spravato?

Generally yes, for treatment-resistant depression with prior authorization.

Are you in network?

Yes, and we bill Blue Shield directly.

Medical benefit or pharmacy benefit?

Usually medical, because the medication is given and monitored in our office.

What about Blue Shield Promise Medi-Cal?

Those plans follow Medi-Cal rules. See Medi-Cal and Spravato.

Also see whether Blue Shield covers TMS.

References

• Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression. Am J Psychiatry. 2019;176(6):428-438. PubMed
• Daly EJ, Trivedi MH, Janik A, et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression. JAMA Psychiatry. 2019;76(9):893-903. PubMed

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.